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Lerma K, Coplon L, Goyal V. Travel for abortion care: implications for clinical practice. Curr Opin Obstet Gynecol 2023; 35:476-483. [PMID: 37916900 DOI: 10.1097/gco.0000000000000915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
PURPOSE OF REVIEW Traveling long distances to obtain abortion care due to restrictions and scarce availability is associated with significant obstacles. We review clinical strategies that can facilitate abortion access and outline considerations to ensure person-centered and equitable care. RECENT FINDINGS Establishing a patient's gestational duration prior to travel may be beneficial to ensure they are eligible for their desired abortion method at the preferred facility or to determine if a multiday procedure is required. If a local ultrasound cannot be obtained prior to travel, evidence demonstrates people can generally estimate their gestational duration accurately. If unable to provide care, clinicians should make timely referrals for abortion. Integration of telemedicine into abortion care is safe and well regarded by patients and should be implemented into service delivery where possible to reduce obstacles to care. Routine in-person follow-up care is not necessary. However, for those who want reassurance, formalized pathways to care should be established to ensure people have access to care in their community. To further minimize travel-related burdens, facilities should routinely offer information about funding and practical support, emotional support, and legal resources. SUMMARY There are many opportunities to optimize clinical practice to support those traveling for abortion care.
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Affiliation(s)
- Klaira Lerma
- Population Research Center, The University of Texas at Austin, Austin, Texas
| | - Leah Coplon
- Abortion On Demand, Seattle, Washington, USA
| | - Vinita Goyal
- Population Research Center, The University of Texas at Austin, Austin, Texas
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2
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Allison BA, Vear K, Hoopes AJ, Maslowsky J. Adolescent Awareness of the Changing Legal Landscape of Abortion in the United States and Its Implications. J Adolesc Health 2023; 73:230-236. [PMID: 37269283 PMCID: PMC10524632 DOI: 10.1016/j.jadohealth.2023.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 04/10/2023] [Accepted: 04/11/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE Restrictions on abortion in the United States will have disproportionate and negative impacts on adolescents. Prior to the Supreme Court ruling to overturn federal protection of abortion, we sought to examine adolescents' awareness and knowledge about the legal landscape of abortion and how changes might affect them. METHODS We fielded a 5-question open-ended survey via text message to a nationwide sample of adolescents aged 14-24 years on May 20, 2022. We coded the responses using inductive consensus coding. Summary statistics were calculated for code frequencies and demographic data, and analyzed qualitatively using visual inspection of results overall and by subgroups (e.g., age, race and ethnicity, gender, and restrictiveness of state of residence). RESULTS A total of 654 responded (79% response rate), of which 11% were under 18 years. Most adolescents were aware of potential changes to abortion access. Most adolescents reported using the internet and social media for information about abortions. Overall, negative emotions about the changing legal landscape predominated, including anger, fear, and sadness. When considering factors for abortion decisions, adolescents most often discussed finances and life circumstances including their future, age, education, maturity, and emotional stability. Themes were relatively, uniformly distributed across subgroups. DISCUSSION Our study suggests that many adolescents are aware of and concerned about potential impacts of abortion restrictions, across a diversity of ages, gender, racial/ethnic, and geographic perspectives. Understanding and amplifying the voices of adolescents during this critical time is necessary to inform novel access solutions and policy initiatives that center the needs of youth.
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Affiliation(s)
- Bianca A Allison
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
| | - Kinsey Vear
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Andrea J Hoopes
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Julie Maslowsky
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, Illinois
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White K, Leyser-Whalen O, Whitfield B, Dane'el A, Andrea A, Rupani A, Kumar B, Moayedi G. Abortion assistance fund staff and volunteers as patient navigators following an abortion ban in Texas. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2023:10.1363/psrh.12240. [PMID: 37491624 PMCID: PMC10808264 DOI: 10.1363/psrh.12240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
CONTEXT Abortion assistance funds constitute an important part of the healthcare safety net by covering some of abortion patients' out-of-pocket costs. Few studies have examined the other ways abortion assistance fund staff and volunteers support callers who need help obtaining care. METHODS Between June and September 2020, we conducted in-depth interviews with 23 staff and volunteers at 11 local abortion assistance funds that helped Texans seeking abortion care following a March 2020 state executive order that prohibited most abortions. Interviewers explored respondents' experiences with callers whose appointments had been canceled or who traveled out of state and subsequent operational changes. We used both inductive and deductive codes in the thematic analysis. RESULTS Abortion assistance fund staff and volunteers bridged callers' information gaps about the services and financial resources available and helped create plans to secure care that accounted for callers' specific needs. They provided emotional support so callers felt it was possible to overcome logistical hurdles to get an abortion, even if that required out-of-state travel. Respondents described greater collaboration between Texas-based abortion assistance funds and out-of-state organizations to support callers' more complex logistical needs and increased costs. Some callers who encountered multiple barriers to care, including interpersonal violence, were unable to obtain an abortion, even with additional supports. CONCLUSIONS Local abortion assistance funds worked with Texas callers to co-create person-centered plans for care and expanded inter-organization collaborations. Initiatives that bolster local assistance funds' infrastructure and capacity will be needed as the abortion access landscape becomes further restricted and complex.
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Affiliation(s)
- Kari White
- Department of Sociology, Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas, USA
| | - Ophra Leyser-Whalen
- Department of Sociology and Anthropology, University of Texas at El Paso, El Paso, Texas, USA
| | - Brooke Whitfield
- Department of Sociology, University of Texas at Austin, Austin, Texas, USA
| | | | | | | | - Bhavik Kumar
- Planned Parenthood Gulf Coast, Houston, Texas, USA
| | - Ghazaleh Moayedi
- Pegasus Health Justice Center, Texas Equal Access Fund, Dallas, Texas, USA
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4
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Hoopes AJ, Maslowsky J, Baca MA, Goldberg J, Harrison ME, Hwang LY, Romano M, Tebb K, Tyson N, Grubb LK. Elevating the Needs of Minor Adolescents in a Landscape of Reduced Abortion Access in the United States. J Adolesc Health 2022; 71:530-532. [PMID: 36096900 PMCID: PMC10511203 DOI: 10.1016/j.jadohealth.2022.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/09/2022] [Accepted: 08/09/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Andrea J Hoopes
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington.
| | - Julie Maslowsky
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - Melanie A Baca
- Department of Family & Community Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Jessica Goldberg
- If/When/How: Lawyering for Reproductive Justice, Oakland, California
| | - Megan E Harrison
- Division of Adolescent Medicine, CHEO, University of Ottawa, Ottawa, Ontario, Canada
| | - Loris Y Hwang
- Department of Pediatrics, Division of Adolescent & Young Adult Medicine, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, California
| | - Mary Romano
- Division of Adolescent Medicine/Young Adult Health, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kathleen Tebb
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, UCSF Benioff Children's Hospital, University of California, San Francisco, San Francisco, California
| | - Nichole Tyson
- Pediatric and Adolescent Gynecology, Division of Gynecologic Specialties, Stanford University School of Medicine, Palo Alto, California
| | - Laura K Grubb
- Division of Adolescent Medicine, Boston Children's Hospital, Boston, Massachusetts
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Abstract
Although teenage pregnancy rates have decreased over the past 30 years, many adolescents become pregnant every year. It is important for pediatricians to have the ability and the resources to make a timely pregnancy diagnosis in their adolescent patients and provide them with nonjudgmental counseling that includes the full range of pregnancy options. Counseling includes an unbiased discussion of the adolescent's options to continue or terminate the pregnancy, supporting the adolescent in the decision-making process, and referring the adolescent to appropriate resources and services. It is important for pediatricians to be familiar with laws and policies impacting access to abortion care, especially for minor adolescents, as well as laws that seek to limit health care professionals' provision of unbiased pregnancy options counseling and referrals, either for abortion care or continuation of pregnancy in accordance with the adolescent's choice. Pediatricians who choose not to provide such discussions should promptly refer pregnant adolescent patients to a health care professional who will offer developmentally appropriate pregnancy options counseling that includes the full range of pregnancy options. Pediatricians should be aware of and oppose policies that restrict their ability to provide pregnant adolescents with unbiased counseling that includes the full range of pregnancy options. This approach to pregnancy options counseling has not changed since the original 1989 American Academy of Pediatrics statement on this issue.
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Baca M, Harrison ME, Grubb L, Hoopes A, Hwang L, Maslowsky J, Romano M, Tebb K, Tyson N. SAHM/NASPAG Statement on Leaked Draft SCOTUS Opinion Regarding Mississippi v Jackson Women's Health. J Pediatr Adolesc Gynecol 2022; 35:417-419. [PMID: 35618232 DOI: 10.1016/j.jpag.2022.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Melanie Baca
- Children's Hospital of Eastern Ontario, Pediatrics, 401 Smyth Rd, Ottawa, ON, Canada K1H8L1, Phone: 613 737 7600
| | - Megan E Harrison
- Children's Hospital of Eastern Ontario, Pediatrics, 401 Smyth Rd, Ottawa, ON, Canada K1H8L1, Phone: 613 737 7600.
| | - Laura Grubb
- Children's Hospital of Eastern Ontario, Pediatrics, 401 Smyth Rd, Ottawa, ON, Canada K1H8L1, Phone: 613 737 7600
| | - Andrea Hoopes
- Children's Hospital of Eastern Ontario, Pediatrics, 401 Smyth Rd, Ottawa, ON, Canada K1H8L1, Phone: 613 737 7600
| | - Loris Hwang
- Children's Hospital of Eastern Ontario, Pediatrics, 401 Smyth Rd, Ottawa, ON, Canada K1H8L1, Phone: 613 737 7600
| | - Julie Maslowsky
- Children's Hospital of Eastern Ontario, Pediatrics, 401 Smyth Rd, Ottawa, ON, Canada K1H8L1, Phone: 613 737 7600
| | - Mary Romano
- Children's Hospital of Eastern Ontario, Pediatrics, 401 Smyth Rd, Ottawa, ON, Canada K1H8L1, Phone: 613 737 7600
| | - Kathleen Tebb
- Children's Hospital of Eastern Ontario, Pediatrics, 401 Smyth Rd, Ottawa, ON, Canada K1H8L1, Phone: 613 737 7600
| | - Nichole Tyson
- Children's Hospital of Eastern Ontario, Pediatrics, 401 Smyth Rd, Ottawa, ON, Canada K1H8L1, Phone: 613 737 7600
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Leyser-Whalen O, Torres L, Gonzales B. Revealing Economic and Racial Injustices: Demographics of Abortion Fund Callers on the U.S.-Mexico Border. WOMEN'S REPRODUCTIVE HEALTH (PHILADELPHIA, PA.) 2022; 8:188-202. [PMID: 35005056 DOI: 10.1080/23293691.2021.1973845] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
There are multiple accessibility challenges to abortion care in the United States. Most abortion research relies on clinic data, whereas we utilized data from an abortion fund on the U.S.-Mexico border. The majority of the sample were Latinx (62.2%), were 20-29 years old (59.7%), were in the first trimester (65.4%), and traveled hundreds of miles to an abortion clinic. Younger age, being in the third trimester, not having insurance, and having some resources were associated with likelihood of receiving aid for an abortion procedure. There is still a great need for abortion funding and access, particularly for young, economically disadvantaged people of color.
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Affiliation(s)
- Ophra Leyser-Whalen
- Department of Sociology & Anthropology, University of Texas at El Paso, El Paso, Texas, USA
| | - Luis Torres
- Department of Sociology & Anthropology, University of Texas at El Paso, El Paso, Texas, USA
| | - Brianna Gonzales
- Department of Sociology & Anthropology, University of Texas at El Paso, El Paso, Texas, USA
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Rice WS, Labgold K, Peterson QT, Higdon M, Njoku O. Sociodemographic and Service Use Characteristics of Abortion Fund Cases from Six States in the U.S. Southeast. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073813. [PMID: 33917408 PMCID: PMC8038751 DOI: 10.3390/ijerph18073813] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/02/2021] [Accepted: 04/03/2021] [Indexed: 11/16/2022]
Abstract
Abortion funds are key actors in mitigating barriers to abortion access, particularly in contexts where state-level abortion access restrictions are concentrated. Using 2017–2019 case management data from a regional abortion fund in the southeastern U.S., we described the sociodemographic and service use characteristics of cases overall (n = 9585) and stratified by state of residence (Alabama, Florida, Georgia, Mississippi, South Carolina, and Tennessee). Overall, cases represented people seeking abortion fund assistance who predominately identified as non-Hispanic Black (81%), 18–34 years of age (84%), publicly or uninsured (87%), having completed a high school degree or some college (70%), having one or more children (77%), and as Christian (58%). Most cases involved an in-state clinic (81%), clinic travel distance under 50 miles (63%), surgical abortion (66%), and pregnancy under 13 weeks’ gestation (73%), with variation across states. The median abortion fund contribution pledge was $75 (interquartile range (IQR): 60–100), supplementing median caller contributions of $200 (IQR: 40–300). These data provide a unique snapshot of a population navigating disproportionate, intersecting barriers to abortion access, and abortion fund capacity for social care and science. Findings can inform abortion fund development, data quality improvement efforts, as well as reproductive health, rights and justice advocacy, policy, and research.
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Affiliation(s)
- Whitney S. Rice
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
- The Center for Reproductive Health Research in the Southeast, Rollins School of Public Health, Emory University, Atlanta, GA 30030, USA;
- Correspondence:
| | - Katie Labgold
- The Center for Reproductive Health Research in the Southeast, Rollins School of Public Health, Emory University, Atlanta, GA 30030, USA;
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | | | | | - Oriaku Njoku
- Access Reproductive Care–Southeast, Atlanta, GA 30357, USA; (Q.T.P.); (O.N.)
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Assifi AR, Kang M, Sullivan EA, Dawson AJ. Abortion care pathways and service provision for adolescents in high-income countries: A qualitative synthesis of the evidence. PLoS One 2020; 15:e0242015. [PMID: 33166365 PMCID: PMC7652292 DOI: 10.1371/journal.pone.0242015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 10/25/2020] [Indexed: 11/29/2022] Open
Abstract
Limited research in high-income countries (HICs) examines adolescent abortion care-seeking pathways. This review aims to examine the pathways and experiences of adolescents when seeking abortion care, and service delivery processes in provision of such care. We undertook a systematic search of the literature to identify relevant studies in HICs (2000–2020). A directed content analysis of qualitative and quantitative studies was conducted. Findings were organised to one or more of three domains of an a priori conceptual framework: context, components of abortion care and access pathway. Thirty-five studies were included. Themes classified to the Context domain included adolescent-specific and restrictive abortion legislation, mostly focused on the United States. Components of abortion care themes included confidentiality, comprehensive care, and abortion procedure. Access pathway themes included delays to access, abortion procedure information, decision-making, clinic operation and environments, and financial and transportation barriers. This review highlights issues affecting access to abortion that are particularly salient for adolescents, including additional legal barriers and challenges receiving care due to their age. Opportunities to enhance abortion access include removing legal barriers, provision of comprehensive care, enhancing the quality of information, and harnessing innovative delivery approaches offered by medical abortion.
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Affiliation(s)
- Anisa R. Assifi
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, Australia
- * E-mail:
| | - Melissa Kang
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Elizabeth A. Sullivan
- Office of the PVC Health and Medicine, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia
| | - Angela J. Dawson
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, Australia
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10
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Assifi AR, Kang M, Sullivan E, Dawson AJ. Assessing care trajectories of adolescent females seeking early induced abortion in New South Wales: multistage, mixed-methods study protocol. BMJ Open 2020; 10:e039819. [PMID: 33093037 PMCID: PMC7583066 DOI: 10.1136/bmjopen-2020-039819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 10/02/2020] [Accepted: 10/06/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION In Australia, New South Wales (NSW), abortion has recently been removed from the criminal code. Previous research from Australia and other high-income countries has focused on adult women's access to abortion services. This protocol describes a five-stage mixed-methods study to determine the care trajectories and experiences of adolescent females, aged 16-19 years, seeking an early induced abortion in NSW. The aims are to (1) explore the needs and perspectives of adolescent females seeking sexual and reproductive health services in NSW and (2) develop a framework for abortion service provision for adolescents in NSW. METHODS AND ANALYSIS This study comprises: (1) semistructured qualitative interviews with key informants, individuals with diverse, in-depth experience of providing and/or supporting abortion care in NSW; (2) a cross-sectional online survey of adolescent females residing in NSW; (3) case study interviews with adolescents females who have accessed an abortion service in NSW; (4) a co-design workshop with adolescents who took part in stage 3 to develop relevant knowledge and recommendations and (5) a knowledge dissemination forum with key stakeholders. ETHICS AND DISSEMINATION Ethics approval has been received from the University of Technology Sydney Human Research Ethics Committee for this study. Data collection commenced in March 2019 and will continue until the end of 2020. This study aims to develop a deep understanding of adolescent abortion care trajectories and experiences of abortion services in NSW. The study will deliver co-produced recommendations to improve adolescent access to abortion information and services.
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Affiliation(s)
- Anisa Rojanapenkul Assifi
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Melissa Kang
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Elizabeth Sullivan
- Office of the PVC Health and Medicine, Faculty of Health and Medicine, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Angela J Dawson
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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Leyser-Whalen O, Chaleshtori SZ, Monteblanco A. Another disaster: Access to abortion after Hurricane Harvey. Health Care Women Int 2020; 41:1111-1127. [PMID: 33170761 PMCID: PMC8018709 DOI: 10.1080/07399332.2020.1833883] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 09/29/2020] [Accepted: 10/05/2020] [Indexed: 10/23/2022]
Abstract
The devastating effects of natural hazards uncover and exacerbate social inequalities, yet reproductive health outcomes are often overlooked. Despite a small but growing literature on gender and disaster-related impacts, there are no studies to date to our knowledge on the intersection of abortion and disasters, which is important because abortion is common in the U.S. and is a critical component of comprehensive reproductive healthcare yet is routinely inaccessible due to a lack of health insurance coverage and other policy barriers. This is a qualitative case study of 8 individuals who required abortion services in Texas at the time of Hurricane Harvey. The study sample comes from caller data from a local Texas abortion fund. We present caller demographics, which reveal nonwhite patients in later trimesters struggling economically. Callers display a need for funding, particularly for travel, and were affected by interpersonal and sexual violence. We conclude with policy and research implications for disaster planners, domestic violence organizations, state and federal officials, and health insurers.
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Affiliation(s)
- Ophra Leyser-Whalen
- Department of Sociology & Anthropology, The University of Texas at El Paso, El Paso, Texas, USA
| | | | - Adelle Monteblanco
- department of Sociology & Anthropology, Middle Tennessee State University, Murfreesboro, Tennessee, USA
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