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Hoggart L, Purcell C, Bloomer F, Newton V, Oluseye A. Social connectedness and supported self-management of early medication abortion in the UK: experiences from the COVID-19 pandemic and learning for the future. CULTURE, HEALTH & SEXUALITY 2024; 26:855-870. [PMID: 37830180 DOI: 10.1080/13691058.2023.2258189] [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: 02/21/2023] [Accepted: 09/08/2023] [Indexed: 10/14/2023]
Abstract
Medication abortion has been established globally as safe and effective. This modality has increased accessibility and the opportunity to centre individual autonomy at the heart of abortion care, by facilitating self-managed abortion. Previous research has shown how self-managed abortion is beneficial in myriad settings ranging from problematic to (relatively) unproblematic contexts of access. In this paper we explore the relationship between self-management and sources of support (including health professionals, family, and friends); as well as considering issues of reproductive control and autonomy. Drawing on qualitative, experience-centred interviews, we utilise the concept of social connectedness to examine how supported self-managed abortion was experienced in the United Kingdom during the COVID-19 pandemic. Overall, self-management was welcomed, with participants speaking positively about managing their own abortion at home. However, a sense of connectedness was crucial in helping participants deal with difficult experiences; and functioned to support individual autonomy in self-care. This paper is the first to examine factors of connection, support, and isolation, as experienced by those undergoing self-managed abortion in the UK in detail. Our research suggests a continued need to advocate for high quality support for self-managed abortion, as well as for choice of abortion method, to support patient-centered care.
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Affiliation(s)
- Lesley Hoggart
- Faculty of Wellbeing, Education & Language Studies, Open University, Milton Keynes, UK
| | - Carrie Purcell
- Faculty of Wellbeing, Education & Language Studies, Open University, Milton Keynes, UK
| | - Fiona Bloomer
- School of Applied Social and Policy Sciences, Ulster University, Belfast, UK
| | - Victoria Newton
- Faculty of Wellbeing, Education & Language Studies, Open University, Milton Keynes, UK
| | - Ayomide Oluseye
- Faculty of Wellbeing, Education & Language Studies, Open University, Milton Keynes, UK
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2
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Luchetti G, Albardonedo V, Alfonso MV. [Women's rescuers network: Community support for self-managed abortion in Argentina]. Salud Colect 2024; 20:e4810. [PMID: 38992339 DOI: 10.18294/sc.2024.4810] [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: 02/17/2024] [Accepted: 05/30/2024] [Indexed: 07/13/2024] Open
Abstract
The availability of medications to induce abortion, especially in contexts of restricted access, has transformed practices and allowed women and/or their community organizations to assist other women in obtaining abortions, whether or not they interact with the healthcare system. This study recovers the experience of a feminist community organization that, from the province of Neuquén, extends throughout the country, creating a network of community care. An exploratory descriptive study with a qualitative approach was conducted to analyze the experiences of women who facilitate access to permitted abortion in Argentina. Through in-depth interviews with three leaders of the feminist collective La Revuelta and semi-structured interviews with 33 members of the socorrista groups, conducted between November 2019 and December 2020, we describe their history and processes of work and growth; we explore their motivations and feelings and characterize the interactions of these organizations with public and private health systems. The results of this work align with the international conversation and bibliographic production about these organizations and their particularities, and with the need to incorporate these forms of care into institutional health systems.
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Affiliation(s)
- Gabriela Luchetti
- Médica, ginecóloga-obstetra. Magíster en Genero Sociedad y Políticas. Profesora adjunta, Facultad de Medicina, Universidad Nacional del Comahue, Neuquén, Argentina
| | - Valeria Albardonedo
- Licenciada en Comunicación Social. Magíster en Ciencias Sociales. Asistente Docencia, Facultad de Medicina, Universidad Nacional del Comahue, Neuquén, Argentina
| | - María Victoria Alfonso
- Licenciada en Comunicación Social. Magíster en Política y Gestión de la Ciencia y la Tecnología. Secretaria, Consejo Superior, Universidad Nacional del Comahue, Neuquén, Argentina
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3
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McCaffrey B. The woman is the active agent: General practitioners and the agentive displacement of abortion in Ireland. Med Anthropol Q 2024; 38:193-207. [PMID: 38630020 DOI: 10.1111/maq.12856] [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] [Received: 06/18/2023] [Accepted: 02/25/2024] [Indexed: 06/07/2024]
Abstract
After the legalization of abortion in 2018, Ireland needed clinicians to become abortion providers and make this political win a medical reality. Yet Irish doctors had next-to-no training in abortion care, and barriers ranging from stigma to economic pressures in the healthcare system impacted doctors' desire to volunteer. How did hundreds of Irish doctors make the shift from family doctor to abortion provider? Drawing on ethnographic research conducted between 2017 and 2020, this article explores the process by which Irish general practitioners became abortion providers, attending to the material impact of medical technologies on that journey. Drawing from medical anthropologists who have examined similar themes of agency, pharmaceuticals, and medico-legal frameworks within the topic of assisted dying, I build on Anita Hannig's idea of "agentive displacement" to frame the productive impact of abortion pills on this transition.
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Affiliation(s)
- Brenna McCaffrey
- Department of Anthropology, SUNY Geneseo, Geneseo, New York, USA
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4
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Footman K. Revolution in abortion care? Perspectives of key informants on the importance of abortion method choice in the era of telemedicine. Sex Reprod Health Matters 2023; 31:2149379. [PMID: 36876426 PMCID: PMC10013513 DOI: 10.1080/26410397.2022.2149379] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Abstract
Patient choice of medical or surgical abortion is a standard of quality abortion care, but the choice of surgical abortion is constrained in England and Wales, particularly since the COVID-19 pandemic and introduction of telemedicine. This qualitative study explored the perspectives of abortion service providers, managers, and funders on the need to offer a choice of methods within early gestation abortion services in England and Wales. Twenty-seven key informant interviews were conducted between August and November 2021, and framework analysis methods were used. Participants presented arguments both for and against offering method choice. Most participants felt that it was important to maintain choice, although they recognised that medical abortion suits most patients, that both methods are very safe and acceptable, and that the priority for abortion services is to maintain timely access to respectful care. Their arguments related to practicalities around patient needs, the risk of reinforcing inequalities in access to patient-centred care, potential impacts on patients and providers, comparisons to other services, costs, and moral issues. Participants argued that constraining choice has a greater impact on those who are less able to advocate for themselves and there were concerns that patients may feel stigmatised or isolated when unable to choose their preferred method. In conclusion, although medical abortion suits most patients, this study highlights arguments for maintaining the option of surgical abortion in the era of telemedicine. More nuanced discussion of the potential benefits and impacts of self-management of medical abortion is needed.
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Affiliation(s)
- Katy Footman
- PhD Candidate, London School of Economics, London, UK. Correspondence:
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5
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Strong J, Coast E, Freeman E, Moore AM, Norris AH, Owolabi O, Rocca CH. Pregnancy recognition trajectories: a needed framework. Sex Reprod Health Matters 2023; 31:2167552. [PMID: 36799663 DOI: 10.1080/26410397.2023.2167552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Affiliation(s)
- Joe Strong
- PhD Candidate, London School of Economics and Political Science, London, UK. Correspondence:
| | - Ernestina Coast
- Professor of Health and International Development, London School of Economics and Political Science, London, UK
| | - Emily Freeman
- Assistant Professorial Research Fellow, London School of Economics and Political Science, London, UK
| | - Ann M Moore
- Principal Research Scientist, Guttmacher Institute, New York, NY, USA
| | - Alison H Norris
- Associate Professor, College of Public Health, Ohio State University, Columbus, OH, USA
| | - Onikepe Owolabi
- Senior Global Director, MNCH/FP, IntraHealth International, Chapel Hill, NC, USA
| | - Corinne H Rocca
- Professor, Department of Obstetrics, Gynecology and Reproductive Sciences, Advancing New Standards in Reproductive Health (ANSIRH), University of California San Francisco, Oakland, CA, USA
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6
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Luigi-Bravo G, Maria Ramirez A, Gerdts C, Gill R. Lessons learned from developing and implementing digital health tools for self-managed abortion and sexual and reproductive healthcare in Canada, the United States, and Venezuela. Sex Reprod Health Matters 2023; 31:2266305. [PMID: 37870150 PMCID: PMC10595388 DOI: 10.1080/26410397.2023.2266305] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023] Open
Affiliation(s)
| | | | - Caitlin Gerdts
- Vice President for Research, Ibis Reproductive Health, Oakland, CA, USA
| | - Roopan Gill
- Executive Director and Co-founder, Vitala Global Foundation, Vancouver, Canada
- Clinician Investigator, Assistant Professor, Department of Obstetrics & Gynecology, University of Toronto, Toronto, Canada
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Lindsey A, Narasimhan S, Sayyad A, Turner D, Mosley EA. " I can be pro-abortion and pro-birth": Opportunities and challenges for full spectrum care among doulas in Georgia. Front Glob Womens Health 2023; 4:966208. [PMID: 36937040 PMCID: PMC10014539 DOI: 10.3389/fgwh.2023.966208] [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: 06/10/2022] [Accepted: 01/02/2023] [Indexed: 03/05/2023] Open
Abstract
Background The work of full spectrum doulas (i.e., non-medically trained care workers offering support before, during, and after pregnancy including abortion)-is increasingly important as abortion access decreases across the U.S. Few studies have examined the work of community-based doulas in restrictive abortion settings or how they might further incorporate full spectrum care. As part of the community-engaged mixed methods Georgia Doula Study, this analysis examines the scope of work of community-based doulas regarding full spectrum and abortion services, doula opinions on full spectrum and abortion work, and potential barriers and facilitators for full spectrum doula care in metro-Atlanta, Georgia. Methods From October 2020 to February 2022, the team recruited 20 community-based doulas with 8 who provide full spectrum services including abortion. Surveys covered demographics, doula scope of work, family planning attitudes, and abortion stigma. Survey data were analyzed using descriptive and bivariate statistics. In-depth interviews further explored those topics. They were de-identified and thematically analyzed using a semi-deductive approach. Results The findings are organized around five themes: (1) doulas of all kinds center reproductive autonomy; (2) abortion doulas play important roles in reproductive autonomy; (3) doulas have mixed feelings about contraceptive counseling; (4) abortion doulas provide diverse services carrying numerous benefits in a stigmatized environment; and (5) abortion doulas experience challenges including stigma but they offer solutions. All but two doulas in this study were interested in learning how to incorporate contraception and abortion services in their current scope of work, and most participants supported the role of full spectrum doulas. Conclusion This analysis highlights the experiences of abortion and full spectrum doulas, reactions of the larger doula community to those services, and facilitators and barriers to full spectrum doula care in a restrictive abortion setting. There are urgent needs and opportunities for full spectrum doulas to offer life-protecting services to pregnant people across the U.S. and globally. Coordination efforts for U.S. abortion care post-Roe v. Wade must include community-based doulas, who are largely open to aiding abortion clients through education, connection to care, and emotional support.
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Affiliation(s)
- Alyssa Lindsey
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
- The Center for Reproductive Health Research in the Southeast, Emory University, Atlanta, GA, United States
| | - Subasri Narasimhan
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
- The Center for Reproductive Health Research in the Southeast, Emory University, Atlanta, GA, United States
| | - Ayeesha Sayyad
- The Center for Reproductive Health Research in the Southeast, Emory University, Atlanta, GA, United States
- Department of Health Policy and Behavioral Sciences, Georgia State University, Atlanta, GA, United States
| | - Daria Turner
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Elizabeth A. Mosley
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
- The Center for Reproductive Health Research in the Southeast, Emory University, Atlanta, GA, United States
- Department of Health Policy and Behavioral Sciences, Georgia State University, Atlanta, GA, United States
- Division of General Internal Medicine, Center for Innovative Research on Gender Health Equity (CONVERGE), University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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8
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Shochet T, Berro Pizzarossa L, Larrea S, Blum J, Jelinska K, Comendant R, Sagaidac I. Self-managed abortion via the internet: Analysis of one year of service delivery data from Women Help Women. Gates Open Res 2023; 7:41. [PMID: 37123048 PMCID: PMC10130357 DOI: 10.12688/gatesopenres.14369.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2023] [Indexed: 02/15/2023] Open
Abstract
Background: To better comprehend the demand for online medication abortion and to inform service delivery practice, we conducted an analysis of Women Help Women (WHW) service delivery statistics. The primary goals were to understand their user profile, evaluate self-reported outcomes and use of other medical services, and assess the overall experience both with the abortion itself and with the counseling and care provided by WHW. Methods: We retrospectively evaluated user characteristics, abortion outcomes, and acceptability of both the medication abortion and WHW’s services, using consultation data and corresponding evaluation data from a one-year period. For users who did not complete the evaluation form, WHW staff reviewed email correspondences to identify key outcomes. Results: From August 2016-July 2017, 3,307 individuals received abortion pills from WHW. Users were geographically located in thirty countries and correspondence was conducted in seven languages. Most reported their gestational age to be less than eight weeks. Of the 2,295 who took the pills and provided outcome information, almost all (99.1%, n=2275) reported that they were no longer pregnant. The majority (84.1%, n=1576/1875) used symptoms to confirm outcome; one fourth (22.8%, n=428) sought an ultrasound and one sixth (18.0%, n=338) used urine and/or serum testing. One in eight users (12.6%, n=292/2317) reported seeking additional medical care after taking the abortion pills. Most (87.5%, n=1551/1773) reported being satisfied or very satisfied with the abortion. Conclusions: Our study confirms that self-managed abortion is a process that people can do safely and effectively with community support and without medical supervision. In the context of a global backlash against abortion rights, self-managed abortion is an integral part of a spectrum of options for abortion care that must be made available to all.
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Affiliation(s)
| | | | - Sara Larrea
- Women Help Women, Amsterdam, The Netherlands
- Independent Researcher, Amstersdam, The Netherlands
| | | | | | - Rodica Comendant
- Women Help Women, Amsterdam, The Netherlands
- Reproductive Health Training Center, Chisinau, Moldova
| | - Irina Sagaidac
- Women Help Women, Amsterdam, The Netherlands
- Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Moldova
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9
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Kristianingrum IA, Nmezi S, Zurbriggen R, Gerdts C, Jayaweera R, Moseson H. Overcoming challenges in research on self-managed medication abortion: lessons from a collaborative activist-researcher partnership. Sex Reprod Health Matters 2022; 30:2077282. [PMID: 35695259 PMCID: PMC9225767 DOI: 10.1080/26410397.2022.2077282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
| | - Sybil Nmezi
- Executive Director, Generation Initiative for Women and Youth Network, Lagos, Nigeria
| | - Ruth Zurbriggen
- Executive Director, Colectiva Feminista la Revuelta, Neuquen, Argentina
| | - Caitlin Gerdts
- Vice President for Research, Ibis Reproductive Health, Oakland, CA, USA
| | - Ruvani Jayaweera
- Research Scientist Research Scientist, Ibis Reproductive Health, Oakland, CA, USA
| | - Heidi Moseson
- Senior Research Scientist, Ibis Reproductive Health, Oakland, CA, USA. Correspondence:
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10
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Strong J, Lamptey NLS, Quartey NK, Owoo NKR. "If I Am Ready": Exploring the relationships between masculinities, pregnancy, and abortion among men in James Town, Ghana. Soc Sci Med 2022; 314:115454. [PMID: 36274458 DOI: 10.1016/j.socscimed.2022.115454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 10/04/2022] [Accepted: 10/09/2022] [Indexed: 11/06/2022]
Abstract
The ability to exercise full sexual and reproductive health and rights is shaped by the contextual environment, meaning that women and pregnant people must navigate patriarchal norms when seeking care. Despite growing evidence that men are able to influence pregnancy outcomes, there remains a paucity of research on how and why men are able to involve themselves in pregnancy and abortion decision-making. This study interrogates the mechanisms that drive men's involvement in pregnancies and abortions in James Town, Ghana. Data from a survey (n = 296) and in-depth interviews (n = 37) were collected between July 2020 and January 2021. The mixed-method analysis critically examined the relationship between men's support for a pregnancy or abortion and their constructions of masculinities. Findings framed sex and reproduction as both a facilitator and a threat to men's masculinity. Reproduction was an essential component of being a man. Men discussed the need to fulfil masculine ideals of being independent, provide financially, and be in an acceptable relationship in order to be 'ready' for fatherhood. However, men similarly operationalised the notion of 'readiness' as the driving force behind their involvement in abortion decision-making. As being a father without being ready could lead to social ostracism and derision, men discussed forcing their abortion desires onto their sexual partners and other pregnant people. Achieving masculine ideals, therefore, was a critical motivation for controlling women and pregnant people's bodies. Understanding the role of masculinities is critical in acknowledging the contextual and environmental factors that women and pregnant people navigate, which contribute to continued reproductive injustices.
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Affiliation(s)
- Joe Strong
- Department of Social Policy, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
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11
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The influence of feminist abortion accompaniment on emotions related to abortion: A longitudinal observational study in Mexico. SSM Popul Health 2022; 19:101259. [PMID: 36238820 PMCID: PMC9552094 DOI: 10.1016/j.ssmph.2022.101259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/28/2022] [Accepted: 10/02/2022] [Indexed: 11/22/2022] Open
Abstract
Emotions can reflect how individuals internalize identities, social roles, and broader power structures, including abortion stigma. Abortion accompaniment, in the form of logistical, informational, and emotional support offered by individuals and organizations, takes a person-centered, feminist, and rights-based approach. We tested the extent to which abortion accompaniment may decrease negative and increase positive feelings an individual holds related to their abortion. Using observational longitudinal data collected between January 2017 and mid-2018, we compared negative and positive emotional responses to a personal abortion experience one month and six months following the abortion to emotions immediately prior to the abortion ("baseline"), among women travelling from outside of Mexico City to abortion clinics in Mexico City with and without support of the accompaniment organization, Fondo MARIA. We used doubly robust longitudinal mixed effects models with inverse probability weighting methods. At baseline, accompanied and unaccompanied participants experienced an average of 4.9 and 4.4 negative emotions out of eight respectively (i.e., anguish, nervousness, scared, anxious, sadness, guilt, anger, shame) and 1.7 and 1.9 positive emotions of out 4 respectively (happiness, calmness, decidedness, and relief). From our model results, women accompanied (n = 77) had larger decreases in negative feelings (p < .05) and larger increases in positive feelings (p < .01) toward their abortion compared to those who were not accompanied (n = 119) at six months. These changes led the majority of accompanied respondents to have primarily positive feelings about their abortion by endline. Abortion accompaniment through Fondo MARIA in Mexico City was associated with a larger decrease in negative feelings, particularly those related to stigma, and a larger increase in positive feelings six months after abortion. Accompaniment's focus on person-centered support, self-determination, and autonomy may enable people seeking abortion to view their decision as one that is valid and legitimate, and resist the predominant stigmatizing narratives framing abortion as something that is transgressive.
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Tiew A, Berro Pizzarossa L, Jastaniah I, Jayaweera RT. The impact of COVID-19 on safe abortion access in Africa: An analysis through a framework of reproductive justice and lens of structural violence. Front Glob Womens Health 2022; 3:958710. [PMID: 36247111 PMCID: PMC9563014 DOI: 10.3389/fgwh.2022.958710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/02/2022] [Indexed: 11/13/2022] Open
Abstract
The SARS-CoV-2 virus causing the coronavirus disease (COVID-19) global pandemic heightened restrictions on sexual and reproductive health and rights (SRHR), especially concerning safe abortion access. The African region has been particularly susceptible to the impact of COVID-19 on sexual and reproductive health services. Using a framework of reproductive justice, we interviewed key informants from the Mobilizing Action around Medication Abortion (MAMA) Network regarding the impacts of structural violence and COVID-19 on SRHR programming in Africa, particularly programming on self-managed abortion. We identified themes of lacking infrastructures of support, emergent marginality, and neocolonial funding environments as facets of structural violence within the context of the MAMA Network, as heightened by the COVID-19 global pandemic.
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Affiliation(s)
- Amanda Tiew
- The International Network for the Reduction of Abortion Discrimination and Stigma (inroads), Seattle, WA, United States
| | - Lucía Berro Pizzarossa
- O'Neill Institute for National and Global Health Law, Georgetown University, Washington, DC, United States
| | | | - Ruvani T. Jayaweera
- Ibis Reproductive Health, Oakland, CA, United States
- *Correspondence: Ruvani T. Jayaweera
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13
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Matthews MM, Lal A, Pacia D. The Role of Epistemic Injustice in Abortion Access Disparities. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2022; 22:49-51. [PMID: 35917417 DOI: 10.1080/15265161.2022.2089288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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14
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Skuster P, Menzel J, Ghorashi AR, Perkins M. Policy surveillance for a global analysis of national abortion laws. Sex Reprod Health Matters 2022; 30:2064208. [PMID: 35583503 PMCID: PMC9122351 DOI: 10.1080/26410397.2022.2064208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Policy surveillance offers a novel and important method for comparing law across jurisdictions. We used policy surveillance to examine abortion laws across the globe. Self-managed abortion, which generally takes place outside formal healthcare settings, is increasing in prevalence and can be safe. We analysed provisions that do not account for the prevalence of self-managed abortion and evidence of its safety. Such provisions require that abortion take place in a formal healthcare setting. We also analysed criminal penalties for non-compliance. Our method included development of a legal framework, an iterative process of refining coding schemes and procedures, and rigorous quality control. We limited our analysis to liberal abortion laws for two reasons. Abortion laws globally trend towards less restrictive. In addition, we aimed to focus on how laws relate to abortion outside a formal healthcare setting specifically and excluded laws that prohibit abortion more broadly. We found that in all countries with liberal national abortion laws, the law permits only healthcare professionals or trained health workers to perform legal abortion and the majority require the abortion to take place in a specified health facility. With policy surveillance methods we can illuminate characteristics of law across many jurisdictions and the need for widespread reform, toward laws that reflect scientific evidence and the way people have abortions.
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Affiliation(s)
- Patty Skuster
- Beck Chair in Law, Temple University Beasley School of Law, Philadelphia, PA, USA. Correspondence:
| | - Jamie Menzel
- Senior Advisor, Research and Evaluation, Ipas, Denver, CO, USA
| | - Adrienne R Ghorashi
- Program Manager, Center for Public Health Law Research, Temple University Beasley School of Law, Philadelphia, PA, USA
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Guendelman S, Pleasants E, Cheshire C, Kong A. Exploring Google Searches for Out-of-Clinic Medication Abortion in the United States During 2020: Infodemiology Approach Using Multiple Samples. JMIR INFODEMIOLOGY 2022; 2:e33184. [PMID: 37113801 PMCID: PMC10014087 DOI: 10.2196/33184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 01/18/2022] [Accepted: 03/31/2022] [Indexed: 04/29/2023]
Abstract
Background As access barriers to in-person abortion care increase due to legal restrictions and COVID-19-related disruptions, individuals may be turning to the internet for information and services on out-of-clinic medication abortions. Google searches allow us to explore timely population-level interest in this topic and assess its implications. Objective We examined the extent to which people searched for out-of-clinic medication abortions in the United States in 2020 through 3 initial search terms: home abortion, self abortion, and buy abortion pill online. Methods Using the Google Trends website, we estimated the relative search index (RSI)-a comparative measure of search popularity-for each initial search term and determined trends and its peak value between January 1, 2020, and January 1, 2021. RSI scores also helped to identify the 10 states where these searches were most popular. We developed a master list of top search queries for each of the initial search terms using the Google Trends application programming interface (API). We estimated the relative search volume (RSV)-the search volume of each query relative to other associated terms-for each of the top queries using the Google Health Trends API. We calculated average RSIs and RSVs from multiple samples to account for low-frequency data. Using the Custom Search API, we determined the top webpages presented to people searching for each of the initial search terms, contextualizing the information found when searching them on Google. Results Searches for home abortion had average RSIs that were 3 times higher than self abortion and almost 4 times higher than buy abortion pill online. Interest in home abortion peaked in November 2020, during the third pandemic wave, at a time when providers could dispense medication abortion using telemedicine and by mail. Home abortion was most frequently queried by searching for Planned Parenthood, abortion pill, and abortion clinic, presumably denoting varying degrees of clinical support. Consistently lower search popularity for self abortion and buy abortion pill online reflect less population interest in mostly or completely self-managed out-of-clinic abortions. We observed the highest interest for home abortion and self abortion in states hostile to abortion, suggesting that state restrictions encourage these online searches. Top webpages provided limited evidence-based clinical content on self-management of abortions, and several antiabortion sites presented health-related disinformation. Conclusions During the pandemic in the United States, there has been considerably more interest in home abortions than in minimally or nonclinically supported self-abortions. While our study was mainly descriptive, showing how infrequent abortion-related search data can be analyzed through multiple resampling, future studies should explore correlations between the keywords denoting interest in out-of-clinic abortion and abortion care measures and test models that allow for improved monitoring and surveillance of abortion concerns in our rapidly evolving policy context.
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Affiliation(s)
- Sylvia Guendelman
- Wallace Center for Maternal, Child, and Adolescent Health School of Public Health University of California, Berkeley Berkeley, CA United States
| | - Elizabeth Pleasants
- Wallace Center for Maternal, Child, and Adolescent Health School of Public Health University of California, Berkeley Berkeley, CA United States
| | - Coye Cheshire
- School of Information University of California, Berkeley Berkeley, CA United States
| | - Ashley Kong
- Computing, Data Science, and Society Program University of California, Berkeley Berkeley, CA United States
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Luigi-Bravo G, Gill RK. Safe abortion within the Venezuelan complex humanitarian emergency: understanding context as key to identifying the potential for digital self-care tools in expanding access. Sex Reprod Health Matters 2022; 29:2067104. [PMID: 35593266 PMCID: PMC9132459 DOI: 10.1080/26410397.2022.2067104] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Génesis Luigi-Bravo
- Community Engagement Lead, Vitala Global Foundation, Vancouver, British Columbia, Canada; Graduate Institue of Geneva, Geneva, Switzerland
| | - Roopan Kaur Gill
- Executive Director, Vitala Global Foundation, Vancouver, British Columbia Canada; Clinican Investigator, Assistant Professor, University of Toronto, Department of Obstetrics & Gynecology, Toronto, Canada. Correspondence:
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17
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Assis MP, Erdman JN. Abortion rights beyond the medico-legal paradigm. Glob Public Health 2021; 17:2235-2250. [PMID: 34487487 DOI: 10.1080/17441692.2021.1971278] [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: 10/20/2022]
Abstract
Abortion rights in international law have historically been framed within a medico-legal paradigm, the belief that regulated systems of legal and medical control guarantee safe abortion. However, a growing worldwide practice of self-managed abortion (SMA) supported by feminist activism challenges key precepts of this paradigm. SMA activism has shown that more than medical service delivery matters to safe abortion and has called into question the legal regulation of abortion beyond criminal prohibitions. This article explores how abortion rights have begun to depart from the medico-legal paradigm and to support the novel norms and practices of SMA activism in a transformation of the abortion field. Abortion rights as reimagined in SMA activism increasingly feature in human rights agendas related to structural violence and inequality, collective organising and international solidarity, and democratic engagement.
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Affiliation(s)
| | - Joanna N Erdman
- Schulich School of Law, Dalhousie University, Halifax, Canada
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Saunders K. Researching relationality: Reflections on the use of concept cards during in-depth interviews. METHODOLOGICAL INNOVATIONS 2021. [DOI: 10.1177/20597991211035525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article reflects on the use of concept cards during in-depth interviews when researching reproductive decision-making in the context of neoliberalism and postfeminism. As existing literature has shown, card methods are valuable in centring participants’ individual experiences through increased control and inclusion during data collection, and attention has been drawn to their use as an ethically attentive method that can elicit richer, more complex narratives than interviews alone. While these strengths initially led me to consider the cards as an appropriate ‘fit’ with my feminist methodological approach, on reflection, the cards also illuminated the relationality of experiences that my research was concerned with. I view this as occurring in two ways. First, participants’ use of the cards helped to uncover the intertwining of their reproductive decisions with the social and political world, therefore complicating the neoliberal prioritization of the individual. Second, the cards brought the relation between myself and the participants, and between the participants, to the forefront. The reflections in this article therefore offer new insights into what concept cards can achieve, as not only validating individual accounts, but as enhancing the relationality of knowledge production.
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Berro Pizzarossa L, Skuster P. Toward Human Rights and Evidence-Based Legal Frameworks for (Self-Managed) Abortion: A Review of the Last Decade of Legal Reform. Health Hum Rights 2021; 23:199-212. [PMID: 34194213 PMCID: PMC8233026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
Since the late 1980s, people have safely self-managed their abortions with medication, changing the landscape of abortion. This practice continues to evolve and expand and has been identified as a cause of decline in severe abortion-related morbidity and mortality. However, developments in medical abortion and self-management have yet to be reflected in the way abortion is regulated. Building on the need for evidence and human rights-based laws, this article explores developments in abortion laws from around the world between 2010 and 2020 to explore the extent to which they have contributed to an enabling environment for self-managed abortion. We focus on recent laws-those adopted in the past 10 years-for which we had access to information for analysis. We observe that laws in force still retain clinical settings and the involvement of medical professionals as the desirable circumstances for an abortion to take place and that even those that have liberalized access still retain some degree of criminalization for the pregnant person who carries out a self-managed abortion or for those who support the process. We conclude that there is enough evidence and support from international human rights standards to ground legal developments that enable self-managed abortion.
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Affiliation(s)
- Lucía Berro Pizzarossa
- Associate at the O’Neill Institute for National and Global Health Law, Georgetown University, Washington, DC, USA
| | - Patty Skuster
- Visiting Professor of Law at Temple University Beasley School of Law, formerly Ipas, Philadelphia, USA
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