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Seymour JW, Higgins JA, Roberts SCM. What attributes of abortion care affect people's decision-making? Results from a discrete choice experiment. Contraception 2024; 131:110327. [PMID: 37979644 DOI: 10.1016/j.contraception.2023.110327] [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: 07/27/2023] [Revised: 11/06/2023] [Accepted: 11/10/2023] [Indexed: 11/20/2023]
Abstract
OBJECTIVES We aimed to measure both stated and experimentally "revealed" abortion provision preferences among US people with capacity for pregnancy. STUDY DESIGN In July 2022, we recruited US residents assigned female sex at birth and aged 18 to 55 years using Prolific, an online survey hosting platform. We asked participants what first-trimester abortion method and delivery model they would prefer. We also assessed abortion care preferences with a discrete choice experiment, which examined the relative importance of the following care attributes: method, distance, wait time for appointment, delivery model (telehealth vs in-clinic), and cost. RESULTS More than half of the 887 respondents (59%) self-reported a slight (22%) or strong (37%) preference for medication compared to aspiration abortion; 11% stated no preference. Our discrete choice experiment found that cost and wait time had a greater effect on hypothetical decision-making than did method and delivery model (discrete choice experiment average importances = 44.3 and 23.2, respectively, compared to 15.9 and 8.2, respectively). Simulations indicated that holding other attributes constant, respondents preferred medication to aspiration abortion and telehealth to in-clinic care. CONCLUSIONS This study, the first to examine abortion preferences in the United States, using a discrete choice experiment, demonstrates the importance of wait time and cost in abortion care decision-making. Our work indicates that for this population, factors related to health care financing and organization may matter more than clinical aspects of care. IMPLICATIONS Although people in this study preferred medication to aspiration abortion and telehealth to in-clinic care, wait time and cost of care played a greater role in care decision-making. Focusing solely on clinical aspects of care (i.e., method, delivery model) may ignore other attributes of care that are particularly important for potential patients.
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Affiliation(s)
- Jane W Seymour
- University of Wisconsin - Madison, Collaborative for Reproductive Equity, Madison, WI, United States.
| | - Jenny A Higgins
- University of Wisconsin - Madison, Collaborative for Reproductive Equity, Madison, WI, United States.
| | - Sarah C M Roberts
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland, CA, United States.
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Rafferty KA, Longbons T. Medication Abortion and Abortion Pill Reversal: An Exploratory Analysis on the Influence of Others in Women's Decision-Making. Cureus 2023; 15:e49973. [PMID: 38179370 PMCID: PMC10765257 DOI: 10.7759/cureus.49973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2023] [Indexed: 01/06/2024] Open
Abstract
Introduction As medication abortion accounts for a growing share of abortions in the United States, an increasing number of women are seeking abortion pill reversal (APR). These decisions are typically not made in isolation. However, little research exists on women's APR decision-making and the role played by people close to them. Methods We surveyed women who contacted a national hotline for information on APR and who completed a two-week treatment protocol with progesterone (n = 67). We analyzed women's open-ended answers using thematic analysis to identify memorable messages about medication abortion and APR. Participants' communication with other people in their lives was assessed using the Isolation subscale of the Individual Level Abortion Stigma (ILAS) scale, and decision-making difficulty was assessed using a Likert scale. Results Thirty-six respondents met the eligibility criteria and filled out the ILAS and decision-difficulty scales. Women tended to talk with family and friends about their medication abortion decisions, while they typically sought information online when deciding about APR. Women reported greater stigma in their disclosures about their abortions than in their disclosures about APR (p = 0.006). Conclusion Memorable messages influence women's decisions to pursue medication abortion and APR.
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Horvath S, Frietsche S. Judicial bypass for minors post- Dobbs. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231219601. [PMID: 38146197 PMCID: PMC10752100 DOI: 10.1177/17455057231219601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 10/19/2023] [Accepted: 11/23/2023] [Indexed: 12/27/2023]
Abstract
State laws that require minors seeking abortion care to notify or obtain consent from a parent or other legal guardian are broadly referred to as parental involvement laws. Judicial bypass allows a minor to petition the court to bypass parental involvement. Even before the Dobbs v Jackson Women's Health Organization decision overturned Roe v Wade on 24 June 2022, 36 states had at least one parental involvement law, making minor access to abortion care even more complex than adult access. Since the Dobbs decision, at least 15 states have completely banned abortion, adding further complexity, geographic barriers, and inequities to the pursuit of reproductive healthcare. In this narrative review and commentary, we explain parental involvement laws and judicial bypass from both a legal and medical perspective, exploring the evolving challenges created by this system in the year post-Dobbs.
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Affiliation(s)
- Sarah Horvath
- Department of Obstetrics and Gynecology, Penn State University College of Medicine, Hershey, PA, USA
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Harvey SM, Gibbs SE, Oakley LP. Association of Medicaid Expansion With Access to Abortion Services for Women With Low Incomes in Oregon. Womens Health Issues 2020; 31:107-113. [PMID: 33168482 DOI: 10.1016/j.whi.2020.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 09/08/2020] [Accepted: 10/07/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Affordable Care Act allowed states to expand Medicaid eligibility for women with low incomes before pregnancy. Women who experience an unintended pregnancy may encounter fewer delays in accessing abortion services if they are already enrolled in Medicaid. In states where the Medicaid program includes coverage for abortion services, Medicaid expansion may increase timely access to abortion services. Oregon has expanded Medicaid and is 1 of 16 states in which the Medicaid program covers abortion services. We explored how Medicaid expansion in Oregon was associated with Medicaid-financed abortion rates and receipt of medication abortion relative to surgical abortion. METHODS Using Medicaid claims and eligibility data we identified women ages 19 to 43 (n = 30,367) who had abortions before the expansion period (2008-2013) and after the expansion period (2014-2016). We used American Community Survey data to estimate the annual number of Oregon women aged 19 to 43 with incomes below 185% of the federal poverty level who would be eligible for a Medicaid-financed abortion. We conducted interrupted time series analyses using negative binomial and logistic regression models. RESULTS Incidence of Medicaid-financed abortion increased from 13.4 in 1,000 women in 2008 to 16.3 in 2016. Medication abortion receipt increased from 11.5% of abortions in 2008 to 31.7% in 2016. For both outcomes, we identified an increasing time trend after Medicaid expansion, followed by a subsequent leveling off of the trend. By the end of 2016, incidence of Medicaid-financed abortion was 4.5 abortions per 1,000 women-years (95% confidence interval, 3.3-5.7) higher than it would have been without expansion and medication abortions comprised a 7.4 percentage point (95% confidence interval, 4.4-10.4) greater share of all abortions. CONCLUSIONS Medicaid expansion was associated with increased receipt of Medicaid-financed abortions and may have reduced out-of-pocket payment among women with low incomes. Increased receipt of medication abortion may indicate that expansion enhanced earlier access to services, possibly as a result of increased prepregnancy Medicaid enrollment, and this earlier access may increase reproductive autonomy and safety.
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Affiliation(s)
- S Marie Harvey
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon.
| | - Susannah E Gibbs
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon
| | - Lisa P Oakley
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon
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LaRoche KJ, Foster AM. “It gives you autonomy over your own choices”: A qualitative study of Canadian abortion patients’ experiences with mifepristone and misoprostol. Contraception 2020; 102:61-65. [DOI: 10.1016/j.contraception.2020.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 04/03/2020] [Accepted: 04/07/2020] [Indexed: 11/27/2022]
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Danet Danet A. [Women's emotional accounts of induced abortion]. GACETA SANITARIA 2020; 35:361-373. [PMID: 32451189 DOI: 10.1016/j.gaceta.2020.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/11/2020] [Accepted: 02/14/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To explore women's emotional accounts of induced abortion, analyzing qualitative scientific publications. METHOD Qualitative systematic review of 19 studies published in PubMed, Science Direct and Scopus from 2010 onwards. The articles based on qualitative research design were revised using inductive content analysis. RESULTS The analysis identified three main themes regarding women's emotional experiences: access to abortion, emotional impact during medical assistance, and individual, relational and sociocultural determinants. The studies showed the variability in women's emotional accounts, mainly determined by the following factors: Access and waiting times, health system, type of intervention, degree of awareness and participation regarding the use of technical and medical technologies, interaction with health professionals, and specificity of individual, relational and sociocultural context. The main emotional difficulties were related to the ethical conflict, the decision-making, the relation with the social and health system and stigma. As main facilitating aspects, women highlighted autonomy in decision-making and emotional support, while barriers referred to social rejection and negative messages perceived from the political, social and health system. CONCLUSIONS The emotional accounts around induced abortion depend on individual and relational factors, as well as on health assistance, all mediated by gender inequalities and bias. Improvements in health assistance refer to an integral and individualized attention, adapted to women's needs.
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Affiliation(s)
- Alina Danet Danet
- Departamento de Organización de Empresas, Marketing y Sociología, Área de Sociología, Universidad de Jaén, Jaén, España.
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Donnelly KZ, Elwyn G, Theiler R, Thompson R. Promoting or Undermining Quality Decision Making? A Qualitative Content Analysis of Patient Decision Aids Comparing Surgical and Medication Abortion. Womens Health Issues 2019; 29:414-423. [PMID: 31266679 DOI: 10.1016/j.whi.2019.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 05/09/2019] [Accepted: 05/24/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To understand, describe, and compare the content of patient decision aids on surgical and medication abortion, including 1) attributes used to describe each method, 2) approaches to clarify patients' values, 3) language used to describe each method, and 4) language used to frame women's decision-making role. STUDY DESIGN We analyzed 49 decision aids identified through a previous systematic review and environmental scan. We used summative content analysis for objectives 1 and 2 and directed content analysis for objectives 3 and 4. RESULTS We identified 37 method attributes. Overall, the attributes privileged medical over practical and emotional information. One decision aid included an explicit values clarification approach, and others included implicit approaches, which varied in length, information consistency, and organization. We identified four themes-information consistency, subjective claims, emotive or ambiguous descriptions, and medication abortion as not a real abortion-related to the methods' descriptions. We identified three themes-agency in choice, unclear emphasis on women's preferences, and endorsement of clinic services-related to women's decision-making role. Of the nine tools that listed factors influencing women's decision making, patient preferences was often listed last. CONCLUSIONS Early abortion method decision aids presented a broad range of information and typically framed the method choice as the woman's. However, their emphasis on medical attributes, use of inconsistent information, and, at times, biased presentation of methods may undermine quality decision making. We recommend adapting an existing decision aid or designing a novel tool based on the content and language that women find most acceptable.
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Affiliation(s)
- Kyla Z Donnelly
- The Dartmouth Centers for Health and Aging, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire
| | - Regan Theiler
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | - Rachel Thompson
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Iyengar K, Klingberg Allvin M, Iyengar SD, Danielsson KG, Essén B. "Who Wants to Go Repeatedly to the Hospital?" Perceptions and Experiences of Simplified Medical Abortion in Rajasthan, India. Glob Qual Nurs Res 2017; 3:2333393616683073. [PMID: 28462355 PMCID: PMC5342849 DOI: 10.1177/2333393616683073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 11/04/2016] [Accepted: 11/04/2016] [Indexed: 11/17/2022] Open
Abstract
The aim of this study is to explore women's experiences and perceptions of home use of misoprostol and of the self-assessment of the outcome of early medical abortion in a low-resource setting in India. In-depth interviews were conducted with 20 women seeking early medical abortion, who administered misoprostol at home and assessed their own outcome of abortion using a low-sensitivity pregnancy test. With home use of misoprostol, women were able to avoid inconvenience of travel, child care, and housework, and maintain confidentiality. The use of a low-sensitivity pregnancy test alleviated women's anxieties about retained products. Majority said they would prefer medical abortion involving a single visit in future. This study provides nuanced understanding of how women manage a simplified medical abortion in the context of low literacy and limited communication facilities. Service delivery guidelines should be revised to allow women to have medical abortion with fewer visits.
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Affiliation(s)
- Kirti Iyengar
- Karolinska University Hospital, Stockholm, Sweden.,Action Research and Training for Health, Udaipur, Rajasthan, India
| | | | - Sharad D Iyengar
- Action Research and Training for Health, Udaipur, Rajasthan, India
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Alemayehu M, Yebyo H, Medhanyie AA, Bayray A, Fantahun M, Goba GK. Determinants of repeated abortion among women of reproductive age attending health facilities in Northern Ethiopia: a case-control study. BMC Public Health 2017; 17:188. [PMID: 28193200 PMCID: PMC5307664 DOI: 10.1186/s12889-017-4106-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 02/03/2017] [Indexed: 11/24/2022] Open
Abstract
Background Every year, an estimated 19–20 million unsafe abortions take place, almost all in developing countries, leading to 68,000 deaths and millions more injured many permanently. Many women throughout the world, experience more than one abortion in their lifetimes. Repeat abortion is an indicator of the larger problem of unintended pregnancy. This study aimed to identify determinants of repeat abortion in Tigray Region, Ethiopia. Methods Unmatched case–control study was conducted in hospitals in Tigray Region, northern Ethiopia, from November 2014 to June 2015. The sample included 105 cases and 204 controls, recruited from among women seeking abortion care at public hospitals. Clients having two or more abortions (“repeat abortion”) were taken as cases and those who had a total of one abortion were taken as controls (“single abortion”). Cases were selected consecutive based on proportional to size allocation while systematic sampling was employed for controls. Data were analyzed using SPSS version 20.0. Binary and multiple variable logistic regression analyses were calculated with 95% CI. Results Mean age of cases was 24 years (±6.85) and 22 years (±6.25) for controls. 79.0% of cases had their sexual debut in less than 18 years of age compared to 57% of controls. 42.2% of controls and 23.8% of cases cited rape as the reason for having an abortion. Study participants who did not understand their fertility cycle and when they were most likely to conceive after menstruation (adjusted odds ratio [AOR] = 2.0, 95% confidence interval [CI]: 1.1–3.7), having a previous abortion using medication (AOR = 3.3, CI: 1.83, 6.11), having multiple sexual partners in the preceding 12 months (AOR = 4.4, CI: 2.39,8.45), perceiving that the abortion procedure is not painful (AOR = 2.3, CI: 1.31,4.26), initiating sexual intercourse before the age of 18 years (AOR = 2.7, CI: 1.49, 5.23) and disclosure to a third-party about terminating the pregnancy (AOR = 2.1, CI: 1.2,3.83) were independent predictors of repeat abortion. Conclusion This study identified several factors correlated with women having repeat abortions. It may be helpful for the Government of Ethiopia to encourage women to delay sexual debut and decrease their number of sexual partners, including by promoting discussion within families about sexuality, to decrease the occurrence of repeated abortion.
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Affiliation(s)
- Mussie Alemayehu
- School of Public Health, Mekelle University, College of Health Sciences, Mekelle, Ethiopia.
| | - Henock Yebyo
- School of Public Health, Mekelle University, College of Health Sciences, Mekelle, Ethiopia
| | - Araya Abrha Medhanyie
- School of Public Health, Mekelle University, College of Health Sciences, Mekelle, Ethiopia
| | - Alemayehu Bayray
- School of Public Health, Mekelle University, College of Health Sciences, Mekelle, Ethiopia
| | - Misganaw Fantahun
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gelila Kidane Goba
- Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, USA
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Newton D, Bayly C, McNamee K, Hardiman A, Bismark M, Webster A, Keogh L. How do women seeking abortion choose between surgical and medical abortion? Perspectives from abortion service providers. Aust N Z J Obstet Gynaecol 2016; 56:523-529. [DOI: 10.1111/ajo.12506] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 06/17/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Danielle Newton
- Gender and Women's Health; Centre for Health Equity; Melbourne School of Population and Global Health; The University of Melbourne; Melbourne Victoria Australia
| | - Chris Bayly
- The Royal Women's Hospital; Parkville Victoria Australia
| | - Kathleen McNamee
- Family Planning Victoria & Department of Obstetrics and Gynaecology; Monash University; Melbourne Victoria Australia
| | - Annarella Hardiman
- Pregnancy Advisory Service; The Royal Women's Hospital; Parkville Victoria Australia
| | - Marie Bismark
- Centre for Health Policy; Melbourne School of Population and Global Health; The University of Melbourne; Melbourne Victoria Australia
| | - Amy Webster
- Women's Health Victoria; Melbourne Victoria Australia
| | - Louise Keogh
- Gender and Women's Health; Centre for Health Equity; Melbourne School of Population and Global Health; The University of Melbourne; Melbourne Victoria Australia
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Donnelly KZ, Thompson R. Medical versus surgical methods of early abortion: protocol for a systematic review and environmental scan of patient decision aids. BMJ Open 2015; 5:e007966. [PMID: 26173718 PMCID: PMC4513513 DOI: 10.1136/bmjopen-2015-007966] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Currently, we lack understanding of the content, quality and impact of patient decision aids to support decision-making between medical and surgical methods of early abortion. We plan to undertake a systematic review of peer-reviewed literature to identify, appraise and describe the impact of early abortion method decision aids evaluated quantitatively (Part I), and an environmental scan to identify and appraise other early abortion method decision aids developed in the US (Part II). METHODS AND ANALYSIS For the systematic review, we will search PubMed, Cochrane Library, CINAHL, EMBASE and PsycINFO databases for articles describing experimental and observational studies evaluating the impact of an early abortion method decision aid on women's decision-making processes and outcomes. For the environmental scan, we will identify decision aids by supplementing the systematic review search with Internet-based searches and key informant consultation. The primary reviewer will assess all studies and decision aids for eligibility, and a second reviewer will also assess a subset of these. Both reviewers will independently assess risk of bias in the studies and abstract data using a piloted form. Finally, both reviewers will assess decision aid quality using the International Patient Decision Aid Standards criteria, ease of readability using Flesch/Flesch-Kincaid tests, and informational content using directed content analysis. ETHICS AND DISSEMINATION As this study does not involve human subjects, ethical approval will not be sought. We aim to disseminate the findings in a scientific journal, via academic and/or professional conferences and among the broader community to contribute knowledge about current early abortion method decision-making support. TRIAL REGISTRATION NUMBER This protocol is registered in the International Prospective Register of Systematic Reviews (CRD42015016717).
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Affiliation(s)
- Kyla Z Donnelly
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
| | - Rachel Thompson
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
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