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Esengen S. 'We had that abortion together': abortion networks and access to il/legal abortions in Turkey. CULTURE, HEALTH & SEXUALITY 2024; 26:1119-1133. [PMID: 38193457 DOI: 10.1080/13691058.2023.2301410] [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: 06/10/2023] [Accepted: 12/30/2023] [Indexed: 01/10/2024]
Abstract
Abortion was legalised in Turkey in 1983 with a 10-week limit, restrictions on who could provide abortions, and spousal or parental consent requirements. Currently, although abortion is legal, because of structural barriers, access is restricted (O'Neil, Altuntaş, and Keskin 2020). This study aimed to investigate how women strategically mobilise their social networks to overcome such restrictions to abortion care. Drawing from 25 in-depth interviews with urban-educated cis-women aged 24-30, I identify three groups within abortion networks: included, excluded and ambiguous. While included groups comprised largely of female family and friends, excluded groups were male family members and organisations, and the ambiguous category included health professionals and partners. Supporting findings in other contexts, individuals initially utilise their abortion networks to access the provider, they then build abortion solidarity networks to act as buffers against groups they wish to exclude during the abortion experience. Additionally, I show that excluded and ambiguous networks also impact abortion access, decision-making, and experience, even pushing individuals to follow through with illegal or semi-legal abortion procedures. Findings draw attention to the structural boundaries surrounding abortion laws, how patriarchal institutions make access to abortion care and abortion networks challenging, and how social networks may be utilised to alleviate such obstacles.
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Affiliation(s)
- Sinem Esengen
- Gender and Women's Studies, Middle East Technical University, Ankara, Turkey
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2
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Adler A, Antonia Biggs M, Kaller S, Schroeder R, Prata N, Scott K, Ralph L. The association of experiences of medical mistrust and mistreatment and ever considering self-managing an abortion. Contraception 2024:110697. [PMID: 39214268 DOI: 10.1016/j.contraception.2024.110697] [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: 03/25/2024] [Revised: 08/16/2024] [Accepted: 08/26/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE To assess the prevalence of ever considering self-managing an abortion (SMA) and its associations with experiences of medical mistrust and mistreatment in a nationally representative sample. STUDY DESIGN In 2021-22, we conducted a national, cross-sectional, online probability-based survey of US people assigned female at birth ages 15-49. Among those who had ever been pregnant, we ran weighted multivariable logistic regressions to examine whether having had difficulty trusting medical providers and/or experiencing medical mistreatment was associated with SMA consideration. RESULTS Of 4260 participants who had ever been pregnant, 5.2% (95% CI, 4.3%-6.3%) ever considered SMA. Additionally, 38.8% (95% CI, 36.8%-40.9%) reported prior moderate medical mistrust; 17.0% (15.4%-18.6%) experienced neglect of symptoms only, and 22.2% (20.6%-24.0%) experienced ridicule or humiliation in a previous healthcare encounter. In multivariable analyses, those who reported prior high medical mistrust had increased odds of considering SMA (aOR=5.2, [95% CI, 2.9-9.2]), compared to those who had no prior medical mistrust. Those who had experienced ridicule or humiliation by healthcare providers had increased odds of considering SMA (aOR=3.8, [95% CI, 2.3-6.1]), compared to those without such experiences. Participants who believed others perceived them as Black or Arab/Middle Eastern, were poor in their youth, or identified as Lesbian, Gay, Bisexual, Transgender, Queer, and other had higher proportions of considering SMA (p-values<0.01). CONCLUSIONS Experiences of medical mistrust and mistreatment are common and are associated with increased likelihood of considering SMA. Those who identified with a structurally minoritized group were more likely to consider SMA, and those whose "street race" was Arab/Middle Eastern had the highest likelihood. IMPLICATIONS If restrictions on abortion continue to increase, individuals may further consider SMA. Our findings suggest a need to create healthcare environments that foster trust and respect, as well as to ensure people have access to safe options for SMA.
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Affiliation(s)
- Aliza Adler
- Innovating Education in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, United States.
| | - M Antonia Biggs
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, United States
| | - Shelly Kaller
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, United States
| | - Rosalyn Schroeder
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, United States
| | - Ndola Prata
- Bixby Center for Population Health and Sustainability, School of Public Health, University of California, Berkeley, CA, United States
| | - Karen Scott
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, United States; Birthing Cultural Rigor, LLC, Nashville, TN, United States
| | - Lauren Ralph
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, United States
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Keefe-Oates B, Filippa S, Janiak E, Zurbriggen R, Grosso B, Chen JT, Gerdts C, Gottlieb B. Seeking abortion accompaniment: experiences and self-managed abortion preferences of hotline callers after abortion legalisation in Argentina. BMJ SEXUAL & REPRODUCTIVE HEALTH 2024:bmjsrh-2023-202209. [PMID: 38889960 DOI: 10.1136/bmjsrh-2023-202209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/16/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Until the legalisation of abortion in Argentina in 2021, the Socorristas en Red, a network of feminist collectives, provided support and information ('accompaniment') to people self-managing their abortion with medications. Following legalisation, the Socorristas continued accompanying people self-managing or accessing abortion through the healthcare system. We conducted a cross-sectional study to understand preferences, experiences and choices about abortion when contacting a Socorristas hotline after legalisation of abortion in Argentina. METHODS We surveyed callers to the Socorristas' hotline in Neuquén, Argentina about their demographics, pregnancy history, reasons for calling, and experiences seeking abortion through the hotline and the healthcare system. We assessed overall prevalence of these experiences, and analysed differences between people who contacted the health system before calling the hotline and those who first called the hotline for services. RESULTS Of the 755 callers in the study, the majority (63.3%) contacted the Socorristas because they trusted them, and 21.7% called because they both trusted the Socorristas and did not want to go to the healthcare system. At the end of the call, most people (95.4%) chose to self-manage their abortion with accompaniment outside the healthcare system. People who called the healthcare system prior to contacting the hotline frequently reported being referred to the Socorristas, as well as challenges scheduling appointments. CONCLUSIONS After legalisation of abortion in Argentina there is continued demand for accompaniment. Globally, ensuring that accompaniment and self-management of abortion is legal and protected will provide individuals with the support and facilitated access to the abortion care they desire.
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Affiliation(s)
- Brianna Keefe-Oates
- Department of Social and Behavioral Sciences, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Sofia Filippa
- Ibis Reproductive Health, Cambridge, Massachusetts, USA
| | - Elizabeth Janiak
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Belén Grosso
- La Revuelta Colectiva Feminista, Neuquén, Argentina
| | - Jarvis T Chen
- Department of Social and Behavioral Sciences, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Barbara Gottlieb
- Department of Social and Behavioral Sciences, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Dutton-Kenny M, Ojanen-Goldsmith A, Dwyer E, Horner D, Prager SW. Supported at-home abortion: An exploratory study of methods, outcomes, and motivations of community-led abortion care in the United States and Canada. Contraception 2024; 132:110368. [PMID: 38232941 DOI: 10.1016/j.contraception.2024.110368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 01/19/2024]
Abstract
OBJECTIVES This an exploratory study aimed to describe methods and outcomes of comprehensive community-led abortion care in the United States and Canada. STUDY DESIGN This community-based participatory research study recruited community abortion providers from the United States and Canada through existing confidential networks. They participated through in-person and online collaboration to design and implement a data collection tool for abortion methods, outcomes, and motivations from clients. We implemented significant security measures to protect participant confidentiality. RESULTS Thirty community providers were recruited, five withdrew, and 12 provided data for 167 at-home abortions. Most abortions occurred between 6 and 10 weeks (104 [62%]). Abortions between 13 and 21 weeks represent 39 cases (23%). Misoprostol only was the most common method (n = 125 [75%]), followed by herbs alone (n = 12 [7%]) and aspiration (n = 12 [7%]). Complications were rare (n = 3 [1.8%]), with 163 complete abortions (98%). The primary motivation for seeking community-led abortion care was avoiding a clinic. CONCLUSIONS Community providers employed various abortion methods with safety and effectiveness profiles comparable to those reported for clinical and community-based abortion care. Clients wanting a different model of abortion care seek out community-led abortions, regardless of whether clinics are legal and accessible. IMPLICATIONS Community-led abortion is a viable choice for patients. Community providers should be recognized for their contributions to abortion access and high-quality, person-centered care. This study demonstrates a broader range of abortion providers and diverse options meeting the need for individualized abortion care.
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Affiliation(s)
| | | | - Erin Dwyer
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA, United States
| | | | - Sarah Ward Prager
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA, United States.
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5
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Lands M, Dyer RL, Seymour JW. Sampling strategies among studies of barriers to abortion in the United States: A scoping review of abortion access research. Contraception 2024; 131:110342. [PMID: 38012964 DOI: 10.1016/j.contraception.2023.110342] [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: 02/06/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVES Understanding barriers to abortion care is particularly important post-Dobbs. However, many abortion access studies recruit from abortion-providing facilities, which overlook individuals who do not present for clinic-based care. To our knowledge, no studies have reviewed research recruitment strategies in the literature or considered how they might affect our knowledge of abortion barriers. We aimed to identify populations included and sampling methods used in studies of abortion barriers in the United States. STUDY DESIGN We used a scoping review protocol to search five databases for articles examining US-based individuals' experiences accessing abortion. We included English-language articles published between January 2011 and February 2022. For included studies, we identified the sampling strategy and population recruited. RESULTS Our search produced 2763 articles, of which 71 met inclusion criteria. Half of the included papers recruited participants at abortion-providing facilities (n = 35), while the remainder recruited from online sources (n = 14), other health clinics (n = 10), professional organizations (n = 8), abortion funds (n = 2), community organizations (n = 2), key informants (n = 2), and an abortion storytelling project (n = 1). Most articles (n = 61) reported information from people discussing their own abortions; the rest asked nonabortion seekers (e.g., physicians, genetic counselors, attorneys) about barriers to care. CONCLUSIONS Studies of abortion barriers enroll participants from a range of venues, but the majority recruit people who obtained abortions, and half recruit from abortion clinics. IMPLICATIONS As abortion access becomes constrained and criminalized in the post-Roe context, our findings indicate how investigators might recruit study participants from a variety of settings to fully understand the abortion seeking experience.
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Affiliation(s)
- Madison Lands
- University of Wisconsin Collaborative for Reproductive Equity, Madison, WI, United States.
| | - Rachel L Dyer
- University of Wisconsin Collaborative for Reproductive Equity, Madison, WI, United States; University of Wisconsin Department of Counseling Psychology, Madison, WI, United States
| | - Jane W Seymour
- University of Wisconsin Collaborative for Reproductive Equity, Madison, WI, United States
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Jung C, Nippita S. Self-managed Medication Abortion in the United States. Clin Obstet Gynecol 2023; 66:739-748. [PMID: 37750672 DOI: 10.1097/grf.0000000000000810] [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: 09/27/2023]
Abstract
Self-managed abortion (SMA) is ending a pregnancy without medical supervision, either by obtaining medications (known as self-managed medication abortion) or through other means. Many factors influence a person's decision to pursue self-managed abortion, such as time constraints, financial considerations, and local availability of abortion services. We present on the prevalence, methods and best practices for clinicians in the United States who may interface with individuals undergoing self-managed medication abortion at any point in the process through a harm reduction approach.
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Affiliation(s)
- Christina Jung
- Department of Obstetrics and Gynecology, NYU Grossman School of Medicine, New York, New York
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7
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Fiastro AE, Young E, Jacob-Files E, Ruben MR, Coeytaux FM, Bennett IM, Godfrey EM. Advance provision of medication for induced abortion: A qualitative study of patient perspectives. Contraception 2023; 123:110050. [PMID: 37085094 DOI: 10.1016/j.contraception.2023.110050] [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: 12/09/2022] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 04/23/2023]
Abstract
OBJECTIVES To examine potential users' perspectives regarding the provision of abortion medications for future use or "advance provision." STUDY DESIGN In this qualitative study, we partnered with an independent reproductive health care clinic in Washington State to conduct semistructured, in-depth interviews with 22 individuals who obtained a medication abortion between August 2021 and January 2022. We asked participants their views on advance provision of abortion medications. Interviews were transcribed and deidentified. Inductive content analysis was used to identify major themes. RESULTS Participants in our sample generally reacted positively to the idea of abortion medications for future use. Having pills in advance could improve timeliness and convenience of care and decrease the stigma associated with their use. Participants stressed the importance of adequate information regarding medication use, what to expect, and potential side effects. Most concerns about advance provision related to the safety and efficacy of medication abortion. CONCLUSIONS This study found that individuals who recently obtained a medication abortion supported the provision of abortion medications for future use. IMPLICATIONS Patient-centered educational materials, with adequate information for self-managing pregnancy termination, can be shared at time of prescription. Clinicians have an opportunity to offer these safe and effective medications in advance of need and increase timely access to this essential health care service. User concerns regarding abortion medications for future use should inform clinical innovation and evaluative research of service options.
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Affiliation(s)
| | | | | | - Molly R Ruben
- University of Washington, Seattle, WA, United States
| | | | - Ian M Bennett
- University of Washington, Seattle, WA, United States
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8
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Feng C, Fay KE, Burns MM. Toxicities of herbal abortifacients. Am J Emerg Med 2023; 68:42-46. [PMID: 36924751 PMCID: PMC10192026 DOI: 10.1016/j.ajem.2023.03.005] [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: 02/07/2023] [Accepted: 03/01/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND In the post-Roe era, barriers to facility-based abortions may lead to an increased incidence of self-managed abortions. While misoprostol-based medication abortions have significant literature supporting its safety profile, there is a knowledge deficit within the medical community regarding the toxicities of commonly used herbal abortifacients. METHODS This is a narrative review, based on a MEDLINE and HOLLIS database search, of self-managed abortion methods with herbal abortifacients and their associated toxicities. RESULTS Common herbal abortifacients with significant morbidity and mortality implications include pennyroyal, blue cohosh, rue, and quinine. Other commonly reported abortifacients considered to be less toxic also are discussed in brief. Special considerations for hepatic, cardiac, renal, and hematologic toxicities are important in patients with significant exposures to these herbal substances. CONCLUSION There is an anticipated increase in the utility of herbal xenobiotics for self-managed abortions with post-Roe restrictions to standard mifepristone-misoprostol protocols. Frontline providers should be aware of the associated toxicities and have special considerations when treating a poisoned patient in this population.
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Affiliation(s)
- Chris Feng
- Harvard Medical Toxicology, Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA.
| | - Kathryn E Fay
- Department of Obstetrics, Gynecology and Reproductive Medicine, Harvard Medical School, Boston, MA, USA
| | - Michele M Burns
- Harvard Medical Toxicology, Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA
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Verma N, Grossman D. Self-Managed Abortion in the United States. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2023; 12:70-75. [PMID: 37305376 PMCID: PMC9989574 DOI: 10.1007/s13669-023-00354-x] [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: 02/21/2023] [Indexed: 03/09/2023]
Abstract
Purpose of Review This review aims to provide up-to-date information about self-managed abortion in the USA. Recent Findings Evidence indicates that there is growing demand for self-managed abortion in the USA as obstacles to facility-based care increase, especially since the Supreme Court overturned Roe v. Wade. Self-managed abortion with medications is safe and effective. Summary Based on a nationally representative survey, the lifetime prevalence of self-managed abortion in the USA in 2017 was estimated to be 7%. People experiencing barriers to abortion care, including people of color, people with lower incomes, people in states that have restrictive abortion laws, and those living farther from facilities providing abortion care are more likely to attempt self-managed abortion. While people may use a range of methods to self-manage abortion, there is growing use of safe and effective medications, including mifepristone used together with misoprostol and misoprostol used alone; use of traumatic and dangerous methods is rare. While many people attempt to self-manage their abortion because of barriers to facility-based care, others have a preference for self-care because it is convenient, accessible, and private. While the medical risks of self-managed abortion may be few, the legal risks may be significant. Sixty-one people have been criminally investigated or arrested between 2000 and 2020 for allegedly self-managing their abortion or helping someone else do so. Clinicians play an important role in providing evidence-based information and care to patients considering or attempting self-managed abortion, as well as minimizing legal risks.
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Affiliation(s)
- Nisha Verma
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA USA
| | - Daniel Grossman
- Advancing New Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco (UCSF), 1330 Broadway, Suite 1100, Oakland, CA 94612 USA
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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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Karlin J, Hodge CC. Intimacy, Anonymity, and "Care with Nothing in the Way" on an Abortion Hotline. Cult Med Psychiatry 2022:10.1007/s11013-022-09810-4. [PMID: 36441388 PMCID: PMC9707088 DOI: 10.1007/s11013-022-09810-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2022] [Indexed: 11/30/2022]
Abstract
This essay is an ethnographic account of a volunteer, anonymous hotline of physicians and advanced practice providers who offer medical advice and guidance to those who are taking medications on their own to end their pregnancies. Attending to the phenomenology of caring on the Hotline reveals a new form of medical expertise at play, which we call "care with nothing in the way." By operating outside the State's scrutiny of abortion provision, the Hotline offers its volunteers a way to practice abortion care that aligns with their professional and political commitments and that distances them from the direct harm they see caused by the political, financial, and bureaucratic constraints of their clinical work. By delineating the structure of this new regime of care, these providers call into question the notion of the "good doctor." They radically re-frame widely shared assumptions about the tenets of the ideal patient-doctor relationship and engender a new form of intimacy-one based, ironically, out of anonymity and not the familiarity that is often idealized in the caregiving relationship. We suggest the implications of "care with nothing in the way" are urgent, not only in the context of increasing hostility to abortion rights, but also for a culture of medicine plagued by physician burnout.
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Affiliation(s)
- Jennifer Karlin
- Department of Family and Community Medicine, University of California, 4860 Y Street, Suite 2320, DavisSacramento, CA 95817 USA
| | - Caroline C. Hodge
- University of California, San Francisco School of Medicine, Department of Anthropology, University of Pennsylvania, 3260 South Street, Philadelphia, PA 19104 USA
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12
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Harries J, Daskilewicz K, Bessenaar T, Gerdts C. Understanding abortion seeking care outside of formal health care settings in Cape Town, South Africa: a qualitative study. Reprod Health 2021; 18:190. [PMID: 34556120 PMCID: PMC8460179 DOI: 10.1186/s12978-021-01243-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/13/2021] [Indexed: 11/26/2022] Open
Abstract
Background Although abortion was legalized in South Africa in 1996, barriers to safe, legal abortion services remain, and women continue to seek abortions outside of the formal healthcare sector. This study explored the decision-making processes that women undertake when faced with an unintended pregnancy, the sources of information used to make their decisions and the factors that contribute to their seeking of informal sector abortion in Cape Town, South Africa. Methods We conducted 15 semi-structured in-depth interviews in English with women who had accessed an abortion outside of the formal health care sector. Women were recruited with the assistance of a community-based key informant. Data was analyzed using a thematic analysis approach. Results Participants were aware that abortions were legal and accessible in public clinics, however they were concerned that others would find out about their unintended pregnancy and abortion if they went to legal providers. Women were also concerned about judgment and mistreatment from providers during their care. Rather than seek care in the formal sector, women looked past concerns around the safety and effectiveness of informal sector abortions and often relied on their social networks for referrals to informal providers. Conclusions The findings highlight the decision-making processes employed by women when seeking abortion services in a setting where abortion is legal and demonstrate the role of institutional and societal barriers to safe abortion access. Abortion service delivery models should adapt to women’s needs to enhance the preferences and priorities of those seeking abortion care-including those who prefer facility-based care as well as those who might prefer self-managed medical abortions. Although abortion was legalized in South Africa in 1996, barriers to safe, legal abortion services remain, and women continue to seek abortions outside of the formal healthcare sector. This study explored the decision-making processes that women undertake when faced with an unintended pregnancy, who they discuss and seek help from, and the factors that influence their decision to seek an abortion outside of the formal health care sector. We interviewed 15 women who had obtained an abortion outside of the health care sector in Cape Town, South Africa. Women were aware that abortions were legal and available in public clinics, but they were concerned about negative and judgmental attitudes from health care providers even though some women were aware of the possible health safety issues related to seeking an abortion outside of the clinic setting. Abortion services should adapt to women’s needs and offer them options of facility-based care but also self-managed medical abortions under the guidance of health care providers.
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Affiliation(s)
- Jane Harries
- Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
| | - Kristen Daskilewicz
- Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Caitlin Gerdts
- Ibis Reproductive Health, 1736 Franklin St, Oakland, CA, USA
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