Comprehension of an Over-the-Counter Drug Facts Label Prototype for a Mifepristone and Misoprostol Medication Abortion Product

Imagining Coat-Hangers and Pills: A Qualitative Exploration of Abortion Beliefs and Attitudes in Hostile Policy Contexts in the United States

OBJECTIVE

We explored awareness of and attitudes about the safety of various methods people use to attempt to end a pregnancy without medical assistance, which we refer to in this study collectively as self-managed abortion (SMA).

METHODS

In 2020, we invited individuals living in eight United States (US) states considered "hostile" to abortion rights or with a history of criminalizing abortions performed outside the formal healthcare system to participate in semi-structured telephone interviews regarding their attitudes toward these practices. We analyzed coded transcripts for content and themes.

RESULTS

We interviewed 54 individuals. Participants perceived methods of ending a pregnancy on one's own to have a high potential for complications, often evoking "coat hanger" abortions. Participants also frequently referenced methods such as physical trauma, herbs, teas, alcohol, or other drugs. Very few participants reported awareness of medication abortion pills. When asked about the safety of SMA in the context of self-sourcing these medications, participants considered pills safer and more acceptable than other SMA methods, while still fearing incorrect use and complications. Others believed that SMA could offer greater reproductive autonomy, less stigma, and a safer physical and psychological experience than facility-based abortion care.

CONCLUSION

In 2020, most participants perceived SMA as involving unsafe practices and did not include use of medication abortion pills. Future research should document how beliefs and attitudes have been influenced by the expansion in telemedicine provision of medication abortion, the implementation of new state abortion bans, and the promulgation of Shield Laws.

Over-the-Counter Medication Abortion as a Strategy to Expand Access to Care

This Viewpoint discusses the growing body of evidence that indicates that mifepristone and misoprostol meet the US Food and Drug Administration’s criteria for over-the-counter sale.

The role (and limits) of developmental neuroscience in determining adolescents' autonomy rights: The case for reproductive and voting rights

Neuroscientific evidence documenting continued neural development throughout adolescence has been leveraged in advocacy for more lenient treatment of adolescents in the criminal justice system. In recent years, developmental science, including neuroscience, has progressed and enabled more nuanced interpretations of what continuing neural development in adolescence likely means functionally for adolescents' capabilities. However, oversimplified interpretations equating continuing neural development to overall "immaturity" are frequently used to make the case that adolescents should have fewer legal rights to make decisions on their own behalf, including regarding reproductive and voting rights. Here we address ongoing debates about adolescents' autonomy rights and whether such rights should be expanded or restricted. We review extant neuroscientific and developmental research that can inform these debates. We call for: (1) a more nuanced application of developmental neuroscience to specific rights issues in specific contexts; (2) additional research designed to inform our understanding of the developmental benefits or harms of rights-based policies on young people over time; and (3) the grounding of developmental neuroscientific research on adolescents within a human rights framework. We offer suggestions to developmental and neuroscience scholars on how to discuss the science of adolescent development with those seeking guidance in their design of law and policy.

Interest in and Support for Alternative Models of Medication Abortion Provision Among Patients Seeking Abortion in the United States

INTRODUCTION

Medication abortion is safe and effective, but restrictions still limit patients from accessing this method. Alternative models of medication abortion provision, namely advance provision, over-the-counter (OTC), and online, could help improve access to care for some, although there is limited evidence about abortion patients' interest in these models.

METHODS

Between 2017 and 2019, we administered a cross-sectional survey to abortion patients at 45 clinics across 15 U.S. states to explore their interest in and support for advance provision, OTC, and online abortion access. We assessed relationships between sociodemographic characteristics and interest in and support for each model using bivariate logistic regressions and present perceived advantages and disadvantages of each model, as described by a subset of participants.

RESULTS

Among 1,965 people enrolled, 1,759 (90%) initiated the survey. Interest in and support for advance provision was highest (72% and 82%, respectively), followed by OTC (63% and 72%) and online access (57% and 70%). In bivariate analyses, non-Hispanic Black and Asian/Pacific Islander respondents expressed lower interest and support for the online model and Alaska Native/Native American respondents expressed higher interest in an OTC model, as compared with white respondents. Among 439 participants naming advantages and disadvantages of each model, the most common advantages included convenience and having the abortion earlier. The most common disadvantages were not seeing a provider first and possibly taking pills incorrectly.

CONCLUSIONS

Although most abortion patients expressed interest in and support for alternative models of medication abortion provision, variation in support across race/ethnicity highlights a need to ensure that abortion care service models meet the needs and preferences of all patients, particularly people from historically underserved populations.

Midwives Safeguarding Abortion Access: Establishing Medication Abortion Services

The abortion access landscape for patients has changed dramatically in the wake of the US Supreme Court Dobbs v. Jackson Women's Health Organization decision in June of 2022. In response, the Division of Midwifery at Baystate Medical Center in Springfield, Massachusetts, began a medication abortion service for both established patients and those who may seek care from out of state. This service increases access to abortion care now while also providing the clinical experience needed for student nurse-midwives to become future abortion providers. This article outlines the steps taken to implement a medication abortion service and ways it can be adopted by other midwifery practices. Strategies to address possible clinical, administrative, and logistical challenges are addressed. Finally, this article is a call to action because midwives are well qualified to provide high quality, safe, and comprehensive medication abortion within the midwifery model of care.

Perspectives on Alternative Models of Medication Abortion Provision Among Abortion Patients in the United States

OBJECTIVE

Restrictions on the availability of medication abortion are a barrier to accessing early abortion. People seeking medication abortion may be interested in obtaining the medications through alternative models. The purpose of this study was to explore patient perspectives on obtaining abortion medications in advance of pregnancy or over the counter (OTC).

STUDY DESIGN

Between October 2017 and August 2018, we conducted 30 in-depth interviews with abortion patients who indicated support for alternative models. We recruited patients from 10 abortion clinics in states with a range of policy environments. We analyzed interviews using inductive and deductive iterative techniques.

RESULTS

Participants identified logistical benefits of these alternative models, including eliminating travel to a clinic and multiple appointments, and increased privacy around decision-making. Participants were interested in advance provision for its convenience and the sense of preparedness that would come with having the pills available at home, yet some had concerns about the pills being found or stolen. Privacy was the key factor considered for OTC access, including both the privacy benefits of avoiding a clinic and the concern of having one's privacy compromised within the community if purchasing the medications in public.

CONCLUSIONS

People who have previously had a medication abortion are interested in alternative methods of provision for reasons concerning convenience, privacy, and avoiding burdens related to hostile policy environments, such as long travel distances to clinics and multiple appointments. Concerns around these models were primarily safety concerns for young people. Further research is needed to evaluate the safety, effectiveness, acceptability, and feasibility of these alternative models of providing medication abortion.

Decreasing reproductive and abortion care barriers: findings on the student health center's role from a student survey

BACKGROUND

College-aged young adults in the US have low utilization and high need for reproductive healthcare. Multiple barriers to reproductive care exist. University Student Health Centers (SHCs) provide varying degrees of reproductive products and services. Recently, California legislated that public university SHCs add medication abortion to their care.

METHODS

To examine existing attitudes and barriers to reproductive healthcare for public university students, we conducted an anonymous online survey at a large, diverse, urban coastal California State University. Students were asked about numerous barriers accessing reproductive services in general and at the SHC, which we categorized into three groups: stigma, access and system. Respondents were also asked about knowledge and preferences for accessing and recommending various services. To understand the extent to which inequities exist, we compared differences across racialized/ethnic identity, gender identity, anticipated degree, and living distance from campus using chi-squared tests.

RESULTS

The majority of survey (n = 273) respondents experienced stigma and access barriers in general healthcare settings which made obtaining reproductive healthcare for themselves or their partners difficult (stigma barriers 55%; 95% CI 49%-61%; access barriers 68%; 95% CI 62-73%). Notably, students reported statistically significant lower rates of access barriers at the SHC, 50%, than in general reproductive healthcare settings, 68%. There were limited differences by student demographics. Students also reported a high willingness to use or recommend the SHC for pregnancy tests (73%; 95% CI 67-78%), emergency contraception pills (72%; 95% CI 66-78%) and medication abortion (60%; 95% CI 54-66%). Students were less likely to know where to access medication abortion compared to other services, suggesting unmet need.

CONCLUSIONS

Our study provides evidence that students face barriers accessing reproductive healthcare and that SHCs are a trusted and accessible source of this care. SHCs have a key role in increasing health, academic and gender equity in the post-Roe era. Attention and financial support must be paid to SHCs to ensure success as state legislatures mandate them to expand reproductive and abortion care access.

Development of a Spanish-language drug facts label prototype for a combination mifepristone and misoprostol medication abortion product

OBJECTIVE

To develop a Spanish-language drug facts label prototype for medication abortion.

STUDY DESIGN

We translated a drug facts label prototype for medication abortion and conducted cognitive video interviews with reproductive age native Spanish speakers to assess and improve its readability.

RESULTS

Thirty-eight people ages 15 to 48 completed cognitive interviews, found the drug facts label easy to understand and suggested minor improvements.

CONCLUSION

Conducting cognitive interviews with native Spanish speakers is a helpful tool to improve readability of a translated label.

IMPLICATIONS

This drug facts label can help to ensure that Spanish speakers have access to easy-to-understand instructions of how to take medication abortion without clinical supervision.