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Kraguljac NV, Bruns DP, Appelbaum PS, Botello E, King VL, Remiszewski N, Widge AS, Alpert JE, Carpenter LL, Grzenda A, Krystal JH, McDonald WM, Nemeroff CB. Post-Roe v Wade psychiatry: legal, clinical, and ethical challenges in psychiatry under abortion bans. Lancet Psychiatry 2024:S2215-0366(24)00096-8. [PMID: 38795722 DOI: 10.1016/s2215-0366(24)00096-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 03/04/2024] [Accepted: 03/12/2024] [Indexed: 05/28/2024]
Abstract
In recent history, the world has witnessed a trend towards liberalization of abortion laws driven by an increasing understanding of the negative personal and public health consequences of criminalizing abortion. By contrast, several countries have recently implemented restrictive reproductive laws, joining the 112 countries where access to abortion care is banned completely or with narrow exceptions. On June 24, 2022, the US Supreme Court ruling in Dobbs v Jackson Women's Health Organization overturned its landmark decisions in Roe v Wade that established abortion until the point of viability of the fetus as a constitutional right. After Roe v Wade having been overturned, it is projected that many women in the USA will be prevented from accessing safe abortion care. Importantly, abortion bans not only impose constraints on patient autonomy, they also restrict physicians' ability to practice evidence-based medicine, which will negatively impact psychiatric care. It is therefore crucial for the practicing psychiatrist to be familiar with this new legal landscape. In this Personal View, we aim to provide a topical overview to help clinicians gain a clear understanding of legal, clinical, and ethical responsibilities, focusing on the USA. We also discuss the reality that psychiatrists might be called upon to determine medical necessity for an abortion on psychiatric grounds, which is new for most US psychiatrists. We predict that psychiatrists will be confronted with very difficult situations in which lawful and ethical conduct might be incongruent, and that abortion bans will result in greater numbers of patients needing psychiatric care from a system that is ill-prepared for additional demands.
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Affiliation(s)
- Nina V Kraguljac
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA.
| | - Debra P Bruns
- Capstone College of Nursing, University of Alabama, Tuscaloosa, AL, USA
| | - Paul S Appelbaum
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Erika Botello
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Victoria L King
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Natalie Remiszewski
- Graduate Biomedical Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Alik S Widge
- Department of Psychiatry and Behavioral Science, University of Minnesota, Minneapolis, MN, USA
| | - Jonathan E Alpert
- Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, New York City, NY, USA
| | - Linda L Carpenter
- Butler Hospital, Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | - Adrienne Grzenda
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - John H Krystal
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - William M McDonald
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Charles B Nemeroff
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin, Austin, TX, USA
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2
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Bruzelius E, Underhill K, Askari MS, Kajeepeta S, Bates L, Prins SJ, Jarlenski M, Martins SS. Punitive legal responses to prenatal drug use in the United States: A survey of state policies and systematic review of their public health impacts. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 126:104380. [PMID: 38484529 PMCID: PMC11056296 DOI: 10.1016/j.drugpo.2024.104380] [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: 10/16/2023] [Revised: 02/05/2024] [Accepted: 02/28/2024] [Indexed: 04/01/2024]
Abstract
BACKGROUND Punitive legal responses to prenatal drug use may be associated with unintended adverse health consequences. However, in a rapidly shifting policy climate, current information has not been summarized. We conducted a survey of U.S. state policies that utilize criminal or civil legal system penalties to address prenatal drug use. We then systematically identified empirical studies evaluating these policies and summarized their potential public health impacts. METHODS Using existing databases and original statutory research, we surveyed current U.S. state-level prenatal drug use policies authorizing explicit criminalization, involuntary commitment, civil child abuse substantiation, and parental rights termination. Next, we systematically identified quantitative associations between these policies and health outcomes, restricting to U.S.-based peer-reviewed research, published January 2000-December 2022. Results described study characteristics and synthesized the evidence on health-related harms and benefits associated with punitive policies. Validity threats were described narratively. RESULTS By 2022, two states had adopted policies explicitly authorizing criminal prosecution, and five states allowed pregnancy-specific and drug use-related involuntary civil commitment. Prenatal drug use was grounds for substantiating civil child abuse and terminating parental rights in 22 and five states, respectively. Of the 16 review-identified articles, most evaluated associations between punitive policies generally (k = 12), or civil child abuse policies specifically (k = 2), and multiple outcomes, including drug treatment utilization (k = 6), maltreatment reporting and foster care entry (k = 5), neonatal drug withdrawal syndrome (NDWS, k = 4) and other pregnancy and birth-related outcomes (k = 3). Most included studies reported null associations or suggested increases in adverse outcome following punitive policy adoption. CONCLUSIONS Nearly half of U.S. states have adopted policies that respond to prenatal drug use with legal system penalties. While additional research is needed to clarify whether such approaches engender overt health harms, current evidence indicates that punitive policies are not associated with public health benefits, and therefore constitute ineffective policy.
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Affiliation(s)
- Emilie Bruzelius
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722W. 168th St. New York, NY 10032, USA.
| | - Kristen Underhill
- Cornell University Law School, 306 Myron Taylor Hall Ithaca, NY 14853-4901, USA
| | - Melanie S Askari
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722W. 168th St. New York, NY 10032, USA
| | - Sandhya Kajeepeta
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722W. 168th St. New York, NY 10032, USA
| | - Lisa Bates
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722W. 168th St. New York, NY 10032, USA
| | - Seth J Prins
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722W. 168th St. New York, NY 10032, USA
| | - Marian Jarlenski
- Department of Health Policy and Management, University of Pittsburgh School of Public Health, A619 130 De Soto Street, Pittsburgh, PA 15261, USA
| | - Silvia S Martins
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722W. 168th St. New York, NY 10032, USA
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3
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Johnson E, Moreland A, King C, Guille C. Black Pregnant and Postpartum Peoples' Perspectives on Mental Health and Substance Use Disorders. J Womens Health (Larchmt) 2024. [PMID: 38529889 DOI: 10.1089/jwh.2023.0464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Abstract
Introduction: Mental health and substance use disorders in pregnant and postpartum people (PPP) are common, and most will not receive adequate treatment. In addition, Black PPP experience higher rates of mental health conditions and are less likely to receive treatment compared with White PPP. Yet, our understanding of the experience of Black PPP with respect to these conditions is limited. The goal of this study was to better understand these experiences with respect to mental health, substance use, and barriers to treatment. Methods: Semi-structured interviews were completed with 68 Black PPP who were pregnant or had been pregnant in the last 24 months to gain an understanding of mental health and substance use screening and treatment during the peripartum and postpartum period. Interview data were analyzed with qualitative software, using a qualitative content analysis method, informed by grounded theory. Results: Four main themes were identified: (1) personal beliefs and views about mental health and substance use, (2) family and community beliefs about mental health and substance use, (3) personal experience with mental health and substance use, and (4) comfort in talking to others about mental health and substance use. Subthemes evolved within each of the four themes. Black PPP indicated that maternal mental health and substance use disorders are common in the Black community, but negative stigma related to these conditions often prevents PPP from talking about these conditions or seeking support or treatment despite believing that support and treatment can be beneficial. Conclusions: Clinical practice initiatives within this population can focus on advanced training for providers to more clearly understand personal experiences and related stigma related to mental health and substance use disorders, with the goal of supporting Black PPP mental health needs.
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Affiliation(s)
- Emily Johnson
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Angela Moreland
- College of Medicine, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Courtney King
- College of Medicine, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Connie Guille
- College of Medicine, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
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Rockhold MN, Gimbel BA, Richardson AA, Kautz-Turnbull C, Speybroeck EL, de Water E, Myers J, Hargrove E, May M, Abdi SS, Petrenko CLM. Racial and ethnic disparities in psychological care for individuals with FASD: a dis/ability studies and critical race theory perspective toward improving prevention, assessment/diagnosis, and intervention. Front Public Health 2024; 12:1355802. [PMID: 38544727 PMCID: PMC10965703 DOI: 10.3389/fpubh.2024.1355802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/16/2024] [Indexed: 05/14/2024] Open
Abstract
Fetal alcohol spectrum disorders (FASD) are among the most common neurodevelopmental disorders and substantially impact public health. FASD can affect people of all races and ethnicities; however, there are important racial and ethnic disparities in alcohol-exposed pregnancy prevention, assessment and diagnosis of FASD, and interventions to support individuals with FASD and their families. In this article we use the Dis/Ability Studies and Critical Race Theory (Dis/Crit) framework to structure the exploration of disparities and possible solutions within these three areas (prevention, diagnosis, intervention). Dis/Crit provides a guide to understanding the intersection of dis/ability and race, while framing both as social constructs. Following the Dis/Crit framework, the systemic, historical, and contemporary racism and ableism present in psychological care is further discussed. We aim to elucidate these racial and ethnic disparities within the fields of psychology and neuropsychology through the Dis/Crit framework and provide potential points of action to reduce these disparities.
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Affiliation(s)
| | - Blake A. Gimbel
- Department of Pediatrics, University of Minnesota Twin Cities, Minneapolis, MN, United States
| | | | | | - Emily L. Speybroeck
- Mt. Hope Family Center, University of Rochester, Rochester, NY, United States
| | - Erik de Water
- Great Lakes Neurobehavioral Center, Edina, MN, United States
| | - Julianne Myers
- Mt. Hope Family Center, University of Rochester, Rochester, NY, United States
| | - Emily Hargrove
- International Adult Leadership Collaborative of FASD Changemakers
| | - Maggie May
- International Adult Leadership Collaborative of FASD Changemakers
| | - Samia S. Abdi
- Department of Pediatrics, University of Minnesota Twin Cities, Minneapolis, MN, United States
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5
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DeBruin DA. Fetal Personhood and the Boundless Responsibilities of Pregnant Persons. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024; 24:33-36. [PMID: 38295245 DOI: 10.1080/15265161.2024.2296778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
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6
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Harris L. Dobbs and Rights during Ongoing Pregnancy: Connecting the Dots. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024; 24:39-41. [PMID: 38295256 DOI: 10.1080/15265161.2024.2296780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
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7
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Goldblatt Hyatt E, Wilpers A, Bahtiyar MO, Hu Y, Leon-Martinez D, Chervenak FA, McCoyd JLM. "I don't have a telephone to the fetus": Clinicians' conceptions of fetal patienthood in maternal-fetal surgery counseling. Soc Sci Med 2024; 342:116525. [PMID: 38199011 DOI: 10.1016/j.socscimed.2023.116525] [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: 07/04/2023] [Revised: 12/01/2023] [Accepted: 12/16/2023] [Indexed: 01/12/2024]
Abstract
RATIONALE Maternal fetal surgery (MFS) has developed rapidly since the 1960s and centers for fetal diagnosis and therapy (CFDT) have proliferated. As a result, CFDT clinicians have intervened with fetuses through pregnant bodies for decades, yet the patienthood status of the fetus and its implications for the pregnant person's autonomy have been relatively unexamined. OBJECTIVE Our overall research aims were threefold: (1) to explore how clinicians train for and provide counseling for MFS; (2) to examine how clinicians assess fetal patienthood and its implications; and (3) to understand clinicians' professed needs and their recommendations for education and training for the provision of MFS counseling. This focuses on aim two. METHOD In this qualitative study, conducted using in-depth interviews, we examined how 20 clinicians from 17 different sites understood fetal patienthood, how that affected their counseling of pregnant patients, and whether they drew on extant ethical frameworks for guidelines. RESULTS We identified three major themes: 1) Clinicians entered fetal surgery consultations with assumptions about fetal patienthood (frequently informed by beliefs about fetal viability, maternal attachment, and disciplinary perspectives); 2) they consciously assessed their pregnant patients' connections to their fetus to inform or re-calibrate their own understandings of fetal patienthood; and 3) they used a threshold -based conceptualization whereby the fetus achieved patienthood after crossing a symbolic boundary, often related to the clinician's ability to intervene. CONCLUSIONS Few clinicians invoked an extant ethical framework to determine fetal patienthood; most asserted that they did not view directive counseling toward MFS as appropriate, instead working diligently to protect pregnant patients' autonomy and rights to self-determination.
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Affiliation(s)
- E Goldblatt Hyatt
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA.
| | - Abigail Wilpers
- Department of Family and Community Health, University of Pennsylvania School of Nursing, 9 Philadelphia, PA, USA; Research Institute, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Mert Ozan Bahtiyar
- Fetal Care Center, Yale New Haven Hospital, New Haven, CT, USA; Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, And Reproductive 15 Sciences, New Haven, CT, USA
| | - Yunzhe Hu
- Columbia University, New York, NY, USA
| | | | - Frank A Chervenak
- Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell 20 and Lenox Hill Hospital, Hempstead, NY, USA
| | - Judith L M McCoyd
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
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8
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Lyerly AD, Waggoner MR. Reproductive Intrusions: Evidence and Ethics. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024; 24:31-33. [PMID: 38295259 PMCID: PMC11017750 DOI: 10.1080/15265161.2023.2296420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
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9
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Minkoff H, Vullikanti RU, Marshall MF. The Two Front War on Reproductive Rights-When the Right to Abortion is Banned, Can the Right to Refuse Obstetrical Interventions Be Far behind? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024; 24:11-20. [PMID: 37830758 DOI: 10.1080/15265161.2023.2262960] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
The loss of the federally protected constitutional right to an abortion is a threat to the already tenuous autonomy of pregnant people, and may augur future challenges to their right to refuse unwanted obstetric interventions. Even before Roe's demise, pregnancy led to constraints on autonomy evidenced by clinician-led legal incursions against patients who refused obstetric interventions. In Dobbs v. Jackson Women's Health Organization, the Supreme Court found that the right to liberty espoused in the Constitution does not extend to a pregnant person's right to an abortion. With Roe's demise, the right to request specific types of care has been vitiated. The same argument underpinning that holding may now become ballast for attacks on the traditionally more robust right, the right to refuse. Here we discuss how the elevation of fetal and embryonic rights may lead to a cascade of medical intrusions and deprivations of liberty against pregnant persons, and offer an argument opposing these improprieties.
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10
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Paltrow LM. When the Right to Abortion is Banned, Can Pregnant Patients Count on Having Any Rights? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024; 24:28-31. [PMID: 38295254 DOI: 10.1080/15265161.2024.2296782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
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11
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McGowan ML, Allyse MA, Condon NA, Wheatley JP, Pensak MJ. From the Front Lines: The Need for Stakeholder Coalitions in Preserving Reproductive Autonomy. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024; 24:46-48. [PMID: 38295260 PMCID: PMC10985837 DOI: 10.1080/15265161.2023.2296405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
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12
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James JE. Reproductive Justice and Abolition: Important Lessons Black Feminists Have Been Teaching Us for Years. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024; 24:55-58. [PMID: 38295241 DOI: 10.1080/15265161.2023.2296415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
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13
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Goodman D. Self-fulfilling Prophecy: Does Structural and Interpersonal Bias Against Pregnant and Postpartum People With Substance Use Disorders Undermine Parenting Identity? J Addict Med 2024; 18:6-8. [PMID: 38315616 DOI: 10.1097/adm.0000000000001241] [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: 02/07/2024]
Abstract
ABSTRACT Pregnant and parenting people with substance use disorders are a highly stigmatized group. Structural and interpersonal bias contribute to reluctance to engage in prenatal, postpartum, and well-child care for this population. Two studies described in this issue of the Journal of Addiction Medicine explore the implications of health care provider-family relationships on experience of care for birthing people with substance use disorders and their infants. Patient voices describe how intensive monitoring of infants for sequelae of substance exposure and that being scrutinized as caregivers undermined their confidence as parents, contributed to self-blame, and damaged their trust in health care teams. Data from these studies suggest that the voices of pregnant and parenting individuals need to be present at local, regional, and national levels to mitigate harm when redesigning programs for this population.
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Affiliation(s)
- Daisy Goodman
- From the Department of Obstetrics and Gynecology, Dartmouth Geisel School of Medicine, Dartmouth Health, Lebanon, NH
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14
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Biggs MA, Becker A, Schroeder R, Kaller S, Scott K, Grossman D, Raifman S, Ralph L. Support for criminalization of self-managed abortion (SMA): A national representative survey. Soc Sci Med 2024; 340:116433. [PMID: 38039765 DOI: 10.1016/j.socscimed.2023.116433] [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: 03/17/2023] [Revised: 10/24/2023] [Accepted: 11/12/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE Since the U.S. Supreme Court eliminated the federal right to abortion, there is a heightened need to understand public opinion about the criminalization of people who attempt to end their pregnancies outside the formal healthcare setting, referred to as self-managed abortion (SMA). We assessed U.S. attitudes about whether three forms of SMA should be legal, reported or punished: 1) using abortion pills obtained outside the healthcare system, 2) using other medications, drugs, herbs, or by drinking alcohol, and 3) using traumatic methods (inserting an object in their body or hitting their stomach). METHODS From December 2021 to January 2022, we administered a national probability-based online survey to English- and Spanish-speaking people assigned female (AFAB, ages 15-49) or male at birth (AMAB, ages 18-49) regarding their attitudes about criminalizing SMA, using Ipsos' KnowledgePanel. We estimated weighted proportions and conducted multivariable regression analyses to identify characteristics associated with support for SMA legality and punishment (reporting to authorities, paying a fine or going to jail). RESULTS A total of 7,016 AFAB and 360 AMAB completed the survey. People were less likely (p < .05) to agree that SMA using abortion pills should be illegal (34% of AFAB and 43% of AMAB) than other forms of SMA (36-48%), although over one-fifth were unsure (AFAB, 20-23% and AMAB, 24-27%). People were less likely to agree SMA using abortion pills should be criminalized than SMA using other drugs, medications, herbs, alcohol or by using traumatic methods. In multivariable analyses, AMAB and Christian religion were associated with agreeing that SMA using abortion pills should be illegal; people who identified as Hispanic/Latinx ethnicity and experienced medical mistreatment were less likely to agree SMA with medication abortion pills should be illegal. CONCLUSIONS Public support for criminalizing SMA is complex and varied by SMA method and form of punishment.
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Affiliation(s)
- M Antonia Biggs
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, Oakland, CA, 94612, USA.
| | - Andréa Becker
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, Oakland, CA, 94612, USA; Department of Sociology, Hunter College, City University of New York, 695 Park Ave NY, NY, 10065, USA
| | - Rosalyn Schroeder
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, Oakland, CA, 94612, USA
| | - Shelly Kaller
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, Oakland, CA, 94612, USA
| | - Karen Scott
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, Oakland, CA, 94612, USA; Birthing Cultural Rigor, LLC, Nashville, TN, 37209, USA
| | - Daniel Grossman
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, Oakland, CA, 94612, USA
| | - Sarah Raifman
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, Oakland, CA, 94612, USA
| | - Lauren Ralph
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, Oakland, CA, 94612, USA
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15
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Martinez NG, Roberts SCM, Achu-Lopes RA, Samura TL, Seidman DL, Woodhams EJ. Reconsidering the use of urine drug testing in reproductive settings. Am J Obstet Gynecol MFM 2023; 5:101206. [PMID: 37871695 DOI: 10.1016/j.ajogmf.2023.101206] [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: 08/02/2023] [Revised: 10/11/2023] [Accepted: 10/18/2023] [Indexed: 10/25/2023]
Abstract
The urine drug test is ubiquitous within reproductive healthcare settings. Although the test can have evidence-based use for a patient and clinician, in practice, it is often applied in ways that are driven by bias and stigma, do not correctly inform decisions about clinical aspects of patient care, and cause devastating ripple effects through social and legal systems. This paper proposes a framework of guiding questions to prompt reflection on (1) the question the clinical team is trying to answer, (2) whether a urine drug test answers the question at hand, (3) how testing benefits compare with the associated risks, (4) a more effective tool for clinical decision-making if the urine drug test does not meet the standards for use, and (5) individual and institutional biases affecting decision-making. We demonstrate the use of this framework using 3 common uses of the urine drug test within abortion care and labor and delivery settings.
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Affiliation(s)
- Noelle G Martinez
- Division of Addiction Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Martinez).
| | - Sarah C M Roberts
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland, CA (Dr Roberts)
| | - Rachel A Achu-Lopes
- Department of Anesthesia, Boston Medical Center, Boston University School of Medicine, Boston, MA (Dr Achu-Lopes)
| | - Tirah L Samura
- Los Angeles County Department of Health Services, Harbor-University of California Los Angeles Medical Center, Los Angeles, CA (Dr Samura); Los Angeles County Department of Health Services, Martin Luther King, Jr. Outpatient Center, Los Angeles, CA (Dr Samura)
| | - Dominika L Seidman
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA (Dr Seidman)
| | - Elisabeth J Woodhams
- Department of Obstetrics & Gynecology, Boston Medical Center, Boston University School of Medicine, Boston, MA (Dr Woodhams)
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16
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Rubashkin N. Epistemic Silences and Experiential Knowledge in Decisions After a First Cesarean: The case of a vaginal birth after cesarean calculator. Med Anthropol Q 2023; 37:341-353. [PMID: 37459454 PMCID: PMC10993819 DOI: 10.1111/maq.12784] [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: 09/24/2022] [Accepted: 05/01/2023] [Indexed: 12/02/2023]
Abstract
Evidence-based obstetrics can employ statistical models to justify greater use of cesareans, sometimes excluding experiential elements from informed decision making. Over the past decade, prenatal providers adopted a vaginal birth after cesarean (VBAC) calculator designed to support patients in making informed decisions about their births by estimating their probability for a VBAC. Among other factors, the calculator used race and ethnicity to make its estimate, assigning lower probabilities for a successful VBAC to Black and Hispanic patients. I analyze how a diverse group of women and their providers engaged with the VBAC calculator. Some providers used low calculator scores to remove a shared decision-making model by prescriptively counseling Black and Hispanic women who desired a VBAC into undergoing repeat cesareans. Consequently, women racialized by the calculator as Black or Hispanic used experiential knowledge to challenge the calculator's assessment of their supposed lesser ability to give birth vaginally.
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Affiliation(s)
- Nicholas Rubashkin
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California at San Francisco, San Francisco, United States
- Institute for Global Health Sciences, University of California at San Francisco, San Francisco, United States
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Downey MM, Daniel C, McGlynn-Wright A, Haugeberg K. Protect and Control: Coverture's Logics Across Welfare Policy and Abortion Law. PSYCHOLOGY OF WOMEN QUARTERLY 2023; 47:478-493. [PMID: 38606316 PMCID: PMC11008606 DOI: 10.1177/03616843231186320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
In the aftermath of Dobbs v. Jackson Women's Health Organization, which overturned the federal constitutional right to abortion, states have begun to recriminalize the procedure. These abortion bans raise important questions about the political and social status of women and pregnant people in the United States. Moreover, restrictions in social welfare programs such as the Special Supplemental Nutrition Assistance Program for Women, Infants, and Children and Temporary Assistance for Needy Families, which serve low-income pregnant people and parents, raise similar questions. The regulation and administration of all three are framed by race, class, and gender. To understand how these restrictions (a) claim to protect women but ultimately function to control, police, and surveil and (b) rely on imagined, stereotype-laden psychological states such as vulnerability, irresponsibility, or irrationality, we turn to the British Common Law doctrine of coverture, which subsumed a married woman's legal, financial, and political identities under her husband's. The American colonies, and later, states of the United States, drew from British Common Law to craft laws that regulated relationships between men and women. Taken together, this analysis can provide a more comprehensive accounting of the cumulative harms experienced by women, poor people, people of color, and pregnant people in today's health and social welfare landscape. We conclude with recommendations for psychologists and other mental health providers to address, in practice and advocacy, the ethical dilemmas and obligations raised by the reach of coverture's logics in people's lives.
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Affiliation(s)
| | - Clare Daniel
- Newcomb Institute, Tulane University, New Orleans,
USA
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18
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Darlington CK, Clark R, Jacoby SF, Terplan M, Alexander K, Compton P. Outcomes and experiences after child custody loss among mothers who use drugs: A mixed studies systematic review. Drug Alcohol Depend 2023; 251:110944. [PMID: 37713979 DOI: 10.1016/j.drugalcdep.2023.110944] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/07/2023] [Accepted: 08/10/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Mothers who use drugs are more likely to experience child custody loss than mothers who do not use drugs. The negative impact of removal on children has been well characterized in current literature while less is known about the impact of custody loss on mothers. The purpose of this mixed studies systematic review is to describe the state of science on the maternal outcomes and experiences after child custody loss among mothers who use drugs. METHODS PubMed, PsycINFO, CINAHL, and Social Work Abstract databases were systematically searched between June 2022 to January 2023. Article eligibility criteria centered on the outcomes and experiences of mothers who use drugs after losing child custody. Studies were analyzed using results-based convergent synthesis methodology for mixed studies reviews. Study quality was assessed using the Mixed Methods Appraisal Tool (MMAT). A visual synthesis model was derived from combined results across all studies. RESULTS Of 2434 articles screened, 22 relevant scientific articles were selected for inclusion. Longitudinal, cohort studies (n=4) and a cross-sectional study (n=1) identified positive associations between custody loss and poorer mental health, increased drug use and overdose risk, less treatment engagement, and worsened social factors. Qualitative studies (n=17) identified themes that described re-traumatization after child custody loss and the development of coping mechanisms through identity negotiation. CONCLUSION Our findings indicate that child custody loss associated with drug use may exacerbate trauma and worsen maternal health. Immediate implications are provided for maternal health policy and practice in healthcare, child welfare, and legal professions.
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Affiliation(s)
- Caroline K Darlington
- University of Pennsylvania School of Nursing, Philadelphia, PA, United States; Leonard Davis Institute of Health Economics, Philadelphia, PA, United States.
| | - Rebecca Clark
- University of Pennsylvania School of Nursing, Philadelphia, PA, United States; Leonard Davis Institute of Health Economics, Philadelphia, PA, United States; Pennsylvania Hospital, Philadelphia, PA, United States
| | - Sara F Jacoby
- University of Pennsylvania School of Nursing, Philadelphia, PA, United States; Leonard Davis Institute of Health Economics, Philadelphia, PA, United States
| | - Mishka Terplan
- Friends Research Institute, Baltimore, MD, United States
| | | | - Peggy Compton
- University of Pennsylvania School of Nursing, Philadelphia, PA, United States; Leonard Davis Institute of Health Economics, Philadelphia, PA, United States
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Rubashkin N, Asiodu I, Vedam S, Sufrin C, Adams V. Patient-Led Approaches to a Vaginal Birth After Cesarean Delivery Calculator. Obstet Gynecol 2023; 142:893-900. [PMID: 37734092 PMCID: PMC10510781 DOI: 10.1097/aog.0000000000005323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/13/2023] [Accepted: 04/20/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE To describe patient approaches to navigating their probability of a vaginal birth after cesarean (VBAC) within the context of prediction scores generated from the original Maternal-Fetal Medicine Units' VBAC calculator, which incorporated race and ethnicity as one of six risk factors. METHODS We invited a diverse group of participants with a history of prior cesarean delivery to participate in interviews and have their prenatal visits recorded. Using an open-ended iterative interview guide, we queried and observed these individuals' mode-of-birth decisions in the context of their VBAC calculator scores. We used a critical and feminist approach to analyze thematic data gleaned from interview and visit transcripts. RESULTS Among the 31 participants who enrolled, their self-identified racial and ethnic categories included: Asian or South Asian (2); Black (4); Hispanic (12); Indigenous (1); White (8); and mixed-Black, -Hispanic, or -Asian background (4). Predicted VBAC success probabilities ranged from 12% to 95%. Participants completed 64 interviews, and 14 prenatal visits were recorded. We identified four themes that demonstrated a range of patient-led approaches to interpreting the probability generated by the VBAC calculator: 1) rejecting the role of race and ethnicity; 2) reframing failure, finding success; 3) factoring the physical experience of labor; and 4) modifying the probability for VBAC. CONCLUSION Our findings demonstrate that a numeric probability for VBAC may not be highly valued or important to all patients, especially those who have strong intentions for VBAC. Black and Hispanic participants challenged the VBAC calculator's incorporation of race and ethnicity as a risk factor and resisted the implication it produced, especially that their bodies were less capable of achieving a vaginal birth. Our findings suggest that patient-led approaches to assessing and interpreting VBAC probability may be an untapped resource for achieving a more person-centered, equitable approach to counseling.
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Affiliation(s)
- Nicholas Rubashkin
- Department of Obstetrics, Gynecology, & Reproductive Sciences, the Institute for Global Health Sciences, the Department of Family Health Care Nursing, School of Nursing, and the Department of Anthropology, History and Social Medicine, University of California, San Francisco, San Francisco, California; the Birth Place Lab and the School of Population & Public Health, University of British Columbia, Vancouver, British Columbia, Canada; and the Department of Gynecology & Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
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20
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Stotland NL. Reproductive Rights and Women's Mental Health. Psychiatr Clin North Am 2023; 46:607-619. [PMID: 37500254 DOI: 10.1016/j.psc.2023.04.014] [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] [Indexed: 07/29/2023]
Abstract
Reproductive rights, including access to comprehensive reproductive health care, are essential to the well-being of women and society. The Dobbs decision of the US Supreme Court has greatly exacerbated the confusion, the stress, and the loss of services. Psychiatrists need to know and communicate the strong scientific evidence of the advantages of sex education, contraception, abortion, and bodily autonomy and to help patients process their feelings and make informed decisions about their own care.
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21
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Taylor J, Shah SA, Lemos NP. The criminalisation of miscarriage associated with illicit substance consumption whilst pregnant. MEDICINE, SCIENCE, AND THE LAW 2023; 63:260-261. [PMID: 36517232 PMCID: PMC10262324 DOI: 10.1177/00258024221140666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Josephine Taylor
- Cameron Forensic Medical Sciences, Centre for Clinical Pharmacology and Precision Medicine, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sajeel A Shah
- Cameron Forensic Medical Sciences, Centre for Clinical Pharmacology and Precision Medicine, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Nikolas P Lemos
- Cameron Forensic Medical Sciences, Centre for Clinical Pharmacology and Precision Medicine, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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22
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Slavin MN, West BS, Levin FR, El-Bassel N. Women with substance use disorders are highly impacted by the overturning of Roe v. Wade: Advocacy steps are urgently needed. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 150:209052. [PMID: 37105267 PMCID: PMC10433178 DOI: 10.1016/j.josat.2023.209052] [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: 09/23/2022] [Revised: 12/22/2022] [Accepted: 04/15/2023] [Indexed: 04/29/2023]
Abstract
The Supreme Court's ruling to overturn the 1973 Roe v. Wade verdict represents a major setback for women's reproductive freedoms in the United States. This ruling revokes constitutional protection for abortion rights and returns the decision to the states. Since this ruling in June 2022, numerous states have adopted total or near total abortion bans, with many of these bans offering no exception for rape, incest, or nonfatal maternal health risks. Legal experts also warn that this ruling can open the door to restrict contraceptive rights previously protected under the same implied constitutional right to privacy as abortion. Already, this decision has increased momentum for states to place restrictions on specific forms of contraception. Certain groups of women will be disproportionately harmed by these bans, such as women with substance use disorders (SUDs). Women with SUDs face unique barriers to sexual and reproductive health services that exist at the structural level (e.g., criminalization; costs and accessibility), interpersonal level (e.g., higher rates of intimate partner violence) and individual level (e.g., reduced reproductive autonomy). These synergistic barriers interact to produce lower contraceptive use, increased unintended pregnancy rates, and subsequently a greater need for abortion services among this population. This ruling will exacerbate the effects of these barriers on women with SUDs, resulting in even greater difficulties accessing contraceptive and abortion services, and ultimately increasing rates of criminalization among pregnant and parenting women with SUDs. This commentary describes these barriers and highlights potential advocacy steps that are urgently needed to assist reproductive-aged women with SUDs during these challenging times when essential health services are increasingly inaccessible.
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Affiliation(s)
| | - Brooke S West
- School of Social Work, Columbia University, New York, NY, USA
| | - Frances R Levin
- Columbia University, Vagelos College of Physicians and Surgeons, USA; New York State Psychiatric Institute, USA
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23
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Swenson K. Cannabis for morning sickness: areas for intervention to decrease cannabis consumption during pregnancy. J Cannabis Res 2023; 5:22. [PMID: 37330589 DOI: 10.1186/s42238-023-00184-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] [Received: 06/29/2022] [Accepted: 04/30/2023] [Indexed: 06/19/2023] Open
Abstract
BACKGROUND Cannabis use during pregnancy is increasing, with 19-22% of patients testing positive at delivery in Colorado and California. Patients report using cannabis to alleviate their nausea and vomiting, anxiety, and pain. However, preclinical and clinical data highlight harmful effects to offspring physiology and behavior following fetal cannabis exposure. This narrative review identifies potential areas for intervention to decrease cannabis consumption during pregnancy. METHODS A combination of keywords, including "cannabis", "cannabis", "weed", "pregnancy", "morning sickness", "child protective services", and "budtender" were searched in databases such as PubMed and Google Scholar, as well as in social media forums, governmental webpages, and other publicly available sources. RESULTS The literature search identified several areas for intervention to reduce cannabis use during pregnancy, including physician and pharmacist training, engagement with pregnant patients, regulation of dispensary workers, and the role of child protective services. DISCUSSION This comprehensive review identifies multiple areas for improvement to benefit pregnant patients. Recommendations are independent and can be implemented simultaneously by the identified groups. Limitations of this research includes the relatively limited availability of data focused specifically on cannabis consumption during pregnancy and the complexity of the sociopolitical field of substance use during pregnancy. CONCLUSIONS Cannabis consumption during pregnancy is increasing and causes harm to the developing fetus. To educate pregnant patients about these risks, we must address the gaps in education from multiple contact points.
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Affiliation(s)
- Karli Swenson
- Department of Pediatrics, Section of Developmental Biology, University of Colorado Anschutz Medical Campus, 12800 E 19th Avenue, RC1 North MS 8313, Aurora, CO, 80045, USA.
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24
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Affiliation(s)
| | - Rieham Owda
- Department of Obstetrics and Gynecology, and
| | | | - Kathleen Collins
- Medical Science Training Program
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
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25
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Rothstein MA. The Illusion of Health Privacy in Obstetrics-Gynecology. Clin Obstet Gynecol 2023; 66:267-277. [PMID: 36645878 DOI: 10.1097/grf.0000000000000771] [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: 01/18/2023]
Abstract
Many health professionals and patients erroneously believe that professional ethics and laws protect the privacy of sensitive records in obstetrics-gynecology. The Health Insurance Portability and Accountability Act Privacy Rule permits disclosure of health records without authorization for public health, law enforcement, and other reasons. Individuals also may be compelled to authorize the release of their records in applying for employment, life insurance, or government benefits. Disclosure of sensitive health information has increased because of comprehensive electronic health records, patient-developed data from mobile devices, consolidation of medical practices, and law enforcement interest in reproductive health records attributable to the change in abortion laws.
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Affiliation(s)
- Mark A Rothstein
- Herbert F. Boehl Chair of Law and Medicine Emeritus, University of Louisville, Rancho Santa Fe, California
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26
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Kennedy S, Nelson L. A Different Take on the Law and Ethics of AWT. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:92-94. [PMID: 37130417 DOI: 10.1080/15265161.2023.2191044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
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27
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Satcher MF, Bruce ML, Goodman DJ, Lord SE. Biopsychosocial contexts of timely and adequate prenatal care utilization among women with criminal legal involvement and opioid use disorder. BMC Public Health 2023; 23:729. [PMID: 37085842 PMCID: PMC10119004 DOI: 10.1186/s12889-023-15627-6] [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: 11/28/2022] [Accepted: 04/07/2023] [Indexed: 04/23/2023] Open
Abstract
OBJECTIVE Pregnant women with criminal legal involvement and opioid use disorder (CL-OUD) living in non-urban regions may be at risk for complex biomedical, psychological, and social barriers to prenatal care and healthy pregnancy. Yet, limited research has explored prenatal care utilization patterns among this subpopulation. This study describes the biopsychosocial factors of pregnant women with a history of criminal legal involvement and opioid use disorder (CL-OUD) associated with timely prenatal care initiation and adequate prenatal care utilization (APNCU). METHODS Analyses were conducted on a subsample of medical record data from an observational comparative effectiveness study of medication treatment models for pregnant women with diagnosed opioid use disorder (OUD) who received prenatal care in Northern New England between 2015 and 2022. The subsample included women aged ≥ 16 years with documented criminal legal involvement. Analyses included χ2, Fisher exact tests, and multiple logistic regression to assess differences in timely prenatal care and APNCU associated with biopsychosocial factors selected by backwards stepwise regression. RESULTS Among 317 women with CL-OUD, 203 (64.0%) received timely prenatal care and 174 (54.9%) received adequate care. Timely prenatal care was associated with having two or three prior pregnancies (aOR 2.37, 95% CI 1.07-5.20), receiving buprenorphine at care initiation (aOR 1.85, 95% CI 1.01-3.41), having stable housing (aOR 2.49, 95% CI 1.41-4.41), and being mandated to court diversion (aOR 4.06, 95% CI 1.54-10.7) or community supervision (aOR 2.05, 95% CI 1.16-3.63). APNCU was associated with having a pregnancy-related medical condition (aOR 2.17, 95% CI 1.27-3.71), receiving MOUD throughout the entire prenatal care period (aOR 3.40, 95% CI 1.45-7.94), having a higher number of psychiatric diagnoses (aOR 1.35, 95% CI 1.07-1.70), attending a rurally-located prenatal care practice (aOR 2.14, 95% CI 1.22-3.76), having stable housing (aOR 1.94, 95% CI 1.06-3.54), and being mandated to court diversion (aOR 3.11, 95% CI 1.19-8.15). CONCLUSION While not causal, results suggest that timely and adequate prenatal care among women with CL-OUD may be supported by OUD treatment, comorbid indications for care, stable access to social resources, and maintained residence in the community (i.e., community-based alternatives to incarceration).
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Affiliation(s)
- Milan F Satcher
- Department of Community and Family Medicine, Dartmouth Health, Lebanon, NH, USA.
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA.
| | - Martha L Bruce
- Department of Community and Family Medicine, Dartmouth Health, Lebanon, NH, USA
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
- Department of Psychiatry, Dartmouth Health, Lebanon, NH, USA
- The Dartmouth Institute, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Daisy J Goodman
- Department of Community and Family Medicine, Dartmouth Health, Lebanon, NH, USA
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
- Department of Obstetrics-Gynecology, Dartmouth Health, Lebanon, NH, USA
| | - Sarah E Lord
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
- Department of Psychiatry, Dartmouth Health, Lebanon, NH, USA
- Department of Pediatrics, Dartmouth Health, Lebanon, NH, USA
- Department of Biomedical Data Sciences, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
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28
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Kao L, Lee C, Parayil T, Kramer C, Sufrin CB. Assessing provision of MOUD and obstetric care in U.S. jails: A content analysis of policies submitted by 59 jails. Drug Alcohol Depend 2023; 248:109877. [PMID: 37244223 DOI: 10.1016/j.drugalcdep.2023.109877] [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] [Received: 02/06/2023] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 05/29/2023]
Abstract
AIMS AND BACKGROUND Thousands of pregnant people with opioid use disorder (OUD) interface with the United States (US) carceral system annually. However, little is known about the consistency and breadth of medications for opioid use disorder (MOUD) for incarcerated pregnant people in jail, even at facilities that offer treatment; the goal of our study is to illuminate the current practices for OUD management in US jails. METHODS We collected and analyzed 59 self-submitted jail policies related to OUD and/or pregnancy from a national, cross-sectional survey of reported MOUD practices for pregnant people in a geographically diverse sample of US jails. Policies were coded for MOUD access, provision, and scope, then compared to respondents' submitted survey responses. RESULTS Of 59 policies, 42 (71%) mentioned OUD care during pregnancy. Among these 42 polices that mentioned OUD care during pregnancy, 41 (98%) allowed MOUD treatment, 24 (57%) expressed continuing pre-existing MOUD treatment that was started in the community pre-arrest, 17 (42%) initiated MOUD in custody, and only 2 (5%) mentioned providing MOUD continuation post-partum. Facilities varied in MOUD duration, provision logistics, and discontinuation policies. Only 11 (19%) policies were completely concordant with their survey response regarding MOUD provision in pregnancy. CONCLUSIONS The conditions, criteria, and the comprehensiveness of MOUD provision and protocols for pregnant people in jail remain variable. The findings demonstrate the need to develop a universal comprehensive MOUD framework for incarcerated pregnant people to reduce the increased likelihood of death from opioid overdose upon release and in the peripartum period.
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Affiliation(s)
- Lynn Kao
- Johns Hopkins University School of Medicine, Department of Gynecology and Obstetrics, 4940 Eastern Ave., A101, Baltimore, MD21224, United States.
| | - Chanel Lee
- Johns Hopkins University School of Medicine, Department of Gynecology and Obstetrics, 4940 Eastern Ave., A101, Baltimore, MD21224, United States
| | - Trisha Parayil
- Johns Hopkins University School of Medicine, Department of Gynecology and Obstetrics, 4940 Eastern Ave., A101, Baltimore, MD21224, United States
| | - Camille Kramer
- Johns Hopkins University School of Medicine, Department of Gynecology and Obstetrics, 4940 Eastern Ave., A101, Baltimore, MD21224, United States
| | - Carolyn B Sufrin
- Johns Hopkins University School of Medicine, Department of Gynecology and Obstetrics, 4940 Eastern Ave., A101, Baltimore, MD21224, United States; Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, 4940 Eastern Ave., A101, Baltimore, MD21224, United States
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Austin T, Lavalley J, Parusel S, Collins AB, Olding M, Boyd J. Women who use drugs: engagement in practices of harm reduction care. Harm Reduct J 2023; 20:49. [PMID: 37055805 PMCID: PMC10100181 DOI: 10.1186/s12954-023-00775-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/28/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Harm reduction services that employ or are operated by people who use drugs are an effective means of mitigating overdose risks and other drug-related harms. However, stereotypes portraying people who use criminalized drugs as incapable caregivers persist. This is especially true for women who use drugs, and to a greater extent racialized women, who are characterized as having diverged from traditional ideals of womanhood as a result of drug-user stigma and the intersections of gender- and class-based and racist stereotypes. In an effort to identify and understand how women who use drugs practise care through harm reduction, we explored the experiences of women accessing a low-threshold supervised consumption site exclusively for women (transgender and non-binary inclusive) in Vancouver, Canada. METHODS Data were drawn from research conducted from May 2017 to June 2018 exploring women's experiences accessing the supervised consumption site during an overdose crisis. Data included forty-five semistructured interviews with women recruited from the site, analysed thematically to explore practices of care through harm reduction. FINDINGS Participants reported engaging in both formal and informal care. Acts of care included interventions that both aligned with and deviated from conventional understandings of care practices, including overdose reversal and education, overdose supervision/care, and assisted injection. CONCLUSION The boundary between formal and informal harm reduction care is fluid. Women who use drugs engage in harm reduction across these borders with acts of care that align with or fill the gaps in current harm reduction services in order to meet the needs of drug-using communities, challenging negative stereotypes of women who use drugs. However, these caregiving practices can increase risks to care providers' physical, mental, and emotional health and wellness. Increased financial, social, and institutional supports, including safer supply, assisted injection, and community resources, are needed to better support women as they continue to engage in harm reduction care.
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Affiliation(s)
- Tamar Austin
- Birth Place Lab, UBC Midwifery, Faculty of Medicine, University Boulevard, Vancouver, BC, 3302-5950, Canada
- British Columbia Centre On Substance Use, St. Paul's Hospital, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer Lavalley
- British Columbia Centre On Substance Use, St. Paul's Hospital, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC, Canada
| | - Sylvia Parusel
- British Columbia Centre On Substance Use, St. Paul's Hospital, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Alexandra B Collins
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Michelle Olding
- British Columbia Centre On Substance Use, St. Paul's Hospital, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC, Canada
| | - Jade Boyd
- British Columbia Centre On Substance Use, St. Paul's Hospital, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.
- Department of Medicine, University of British Columbia, St. Paul's Hospital, Burrard Street, Vancouver, BC, 608-1081, Canada.
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30
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Handler A, McMackin M. Federal Direction + Local Implementation as a Strategy for Improving Infant Health: The Founding and Evolution of the Infant Welfare Society of Evanston. Matern Child Health J 2023:10.1007/s10995-023-03658-9. [PMID: 37017805 DOI: 10.1007/s10995-023-03658-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 04/06/2023]
Abstract
While the role of the US federal government in improving Maternal and Child Health (MCH) is often seen as a history of opportunities and tensions between the federal bureaucracy and state implementation, less is known about how federal governmental policies to improve MCH have been implemented at the local level, and the nature of the dynamic between local implementation and federal adoption of locally generated strategies. By describing the emergence of the Infant Welfare Society of Evanston in the first part of the 20th century and describing its evolution until 1971, we showcase the forces that shaped the emergence of an MCH institution at the local level in the early part of the history of MCH in the US. This article highlights the interaction of a progressive maternalistic frame and the growth of local public health infrastructure as fundamental to the basis of action to address infant health during this period. However, this history also highlights the complex relationship of institutions dominated by White women and their relationship to the populations served in the development of the field of MCH and elucidates the need for more explicit attention to understanding the role of Black social institutions in the development of the field of MCH.
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Affiliation(s)
- Arden Handler
- Community Health Sciences, School of Public Health, The University of Illinois at Chicago, 1603 W. Taylor, Chicago, IL, 60612, USA.
| | - Marla McMackin
- Department of History, Gender and Women's Studies, The University of Illinois at Chicago, Chicago, IL, USA
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31
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Roberts SCM, Zaugg C, Grossman D. Health care provider reporting practices related to self-managed abortion. BMC Womens Health 2023; 23:136. [PMID: 36973776 PMCID: PMC10045784 DOI: 10.1186/s12905-023-02266-7] [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: 11/16/2022] [Accepted: 03/08/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Health care providers reporting patients to government authorities is a main way people attempting self-managed abortion (SMA) become exposed to legal risks. Little is known about health care provider decision-making regarding SMA reporting. METHODS We conducted semi-structured interviews with 37 clinicians who provided care in hospital-based obstetrics or emergency departments (13 obstetricians/gynecologists, two advance practice registered nurses providing obstetrics care, 12 emergency medicine physicians, and 10 family medicine physicians) throughout the United States. The interview guide asked participants to describe one or more cases of caring for a patient who may have attempted SMA and about related reporting decisions. We coded responses to answer two questions: What comes to mind for health care providers when asked to think about experiences caring for a patient who may have attempted SMA? Based on health care provider experiences, how might people who providers suspect may have attempted SMA end up reported? RESULTS About half of participants had cared for someone who may have attempted SMA for that pregnancy. Only two mentioned SMA with misoprostol. Most participants described cases where they were unsure whether the patient had attempted to end their pregnancy on purpose. In most instances, participants mentioned that that the possibility of reporting never occurred to them nor came up. In some cases, participants described a reporting "adjacent" practice - e.g. beginning processes that could lead to substance use, domestic violence, or self-injury/suicide-related reports - or considered reporting related to a perceived need to report abortion complications. In two cases, hospital staff reported to the police and/or Child Protective Services related to the SMA attempt. These involved passing of a fetus after 20 weeks outside the hospital and a domestic violence incident. CONCLUSION Reporting patients who may have attempted SMA may occur via provider perception of a need to report abortion complications and fetal demises, particularly at later gestations, and other reporting requirements (e.g. substance use, domestic violence, child maltreatment, suicide/self-harm).
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Affiliation(s)
- Sarah C M Roberts
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA, 94612, USA.
| | - Claudia Zaugg
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA, 94612, USA
| | - Daniel Grossman
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA, 94612, USA
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Stotland NL. Abortion: Perspectives from an APA Past-President. Psychodyn Psychiatry 2023; 51:1-5. [PMID: 36867185 DOI: 10.1521/pdps.2023.51.1.1] [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] [Indexed: 06/18/2023]
Abstract
The United States Supreme Court's decision in Dobbs v. Jackson Women's Health Organization, eliminating the national right to abortion, poses challenges to psychiatrists and patients. Abortion laws now vary widely from state to state and are constantly changing and being challenged. The laws affect both patients and health care professionals; some prohibit not only the performance of abortion but efforts to inform and assist patients seeking abortion. Patients may become pregnant during and/or because of episodes of clinical depression, mania, or psychosis, and recognize that their current circumstances will not allow them to become adequate parents. Some laws allowing abortion to protect a woman's life or health explicitly exclude mental health risks; many prohibit transfer of a patient to a permissive venue. Psychiatrists working with patients contemplating abortion can convey the scientific evidence that abortion does not cause mental illness and help them identify and work through their own beliefs, values, and likely responses to the decision. Psychiatrists will also have to decide whether medical ethics or state laws will govern their own professional behavior.
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Affiliation(s)
- Nada L Stotland
- Served as the 135th President of the American Psychiatric Association
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Goldfarb SS, Graves K, Geletko K, Hansen MD, Kinsell H, Harman J. Racial and Ethnic Differences in Emergency Department Wait Times for Patients with Substance Use Disorder. J Emerg Med 2023; 64:481-487. [PMID: 36997432 DOI: 10.1016/j.jemermed.2023.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 02/03/2023] [Accepted: 02/17/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Substance use-related morbidity and mortality rates are at an all-time high in the United States, yet there remains significant stigma and discrimination in emergency medicine about patients with this condition. OBJECTIVES The purpose of this study was to determine whether there are racial and ethnic differences in emergency department (ED) wait times among patients with substance use disorder. METHODS The study uses pooled data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2016 to 2018. The dependent variable is length of time the patient with a diagnosis of substance use disorder waited in the ED before being admitted for care. The independent variable is patient race and ethnicity. Adjusted analyses were conducted using a generalized linear model. RESULTS There were a total of 3995 reported ED events among patients reporting a substance use disorder in the NHAMCS sample between 2016 and 2018. After adjusting for covariates, Black patients with substance use disorder were significantly more likely to wait longer in the ED (35% longer) than White patients with substance use disorder (p < 0.01). CONCLUSIONS The findings showed that Black patients with substance use disorder are waiting 35% longer, on average, than White patients with the same condition. This is concerning, given that emergency medicine is a critical frontline of care, and often the only source of care, for these patients. Furthermore, longer wait times can increase the likelihood of leaving the ED without being seen. Programs and policies should address potential stigma and discrimination among providers, and EDs should consider adding people with lived experiences to the staff to serve as peer recovery specialists and bridge the gap for care.
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Affiliation(s)
- Samantha Sittig Goldfarb
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee
| | - Katelyn Graves
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee
| | - Karen Geletko
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee
| | - Megan Deichen Hansen
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee
| | - Heidi Kinsell
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee
| | - Jeff Harman
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee
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Smith MH, McGowan M, Chakraborty P, Hood RB, Field MP, Bessett D, Norwood C, Norris AH. Kentucky's abortion landscape, 2010 to 2019: an analysis of pre- Dobbs abortion disparities in a rural, restrictive state. LANCET REGIONAL HEALTH. AMERICAS 2023; 19:100441. [PMID: 36852333 PMCID: PMC9958464 DOI: 10.1016/j.lana.2023.100441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 01/13/2023] [Accepted: 01/19/2023] [Indexed: 02/17/2023]
Abstract
Background Since 2010, many US states have passed laws restricting abortion providers' ability to provide care. Such legislation has no demonstrated health benefits and creates inequitable barriers for patients. Methods To examine how Kentucky's abortion policies coincided with facility closures and abortion utilisation, we conducted a review of state abortion policies from 2010 to 2019 using newspapers and websites. We calculated abortion rates (abortions per 1000 women ages 15-44) by state of residence and provision for Kentucky, the South, and the US using data from the CDC and Kentucky Department of Health. We calculated percentages leaving and from out-of-state, and analysed abortions by race, pregnancy duration, and method. Findings Of 17 policies passed between 2010 and 2019, ten were enacted, including 20-week and telemedicine bans. One of Kentucky's two abortion facilities closed in 2017. The pooled average abortion rate in Kentucky (4.1) and for Kentuckians (5.8) was lower than national averages (11.8 and 11.1). An average of 38% of Kentuckians left their state for care, compared to 7% nationally. In 2019, the abortion rate in Kentucky was 5.8 times higher for Black patients than White patients (compared to 4.8 times nationally). The majority (62%) of abortions in Kentucky took place at 7-13 weeks' gestation. Interpretation Abortions in Kentucky were less frequent than in the South and US. The larger Black-White abortion rate gap reflects race- and class-based structural inequities in healthcare. Without federal protections, abortion access in Kentucky will continue waning. Funding This study was supported by a philanthropic foundation that makes grants anonymously.
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Affiliation(s)
- Mikaela H. Smith
- Division of Epidemiology, The Ohio State University, College of Public Health, Columbus, OH, USA,Corresponding author.
| | - Michelle McGowan
- Biomedical Ethics Research Program, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA,Department of Women's, Gender & Sexuality Studies, University of Cincinnati, Cincinnati, OH, USA
| | - Payal Chakraborty
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Robert B. Hood
- Department of Epidemiology, Emory University, Rollins School of Public Health, Atlanta, GA, USA
| | | | - Danielle Bessett
- Department of Sociology, University of Cincinnati, Cincinnati, OH, USA
| | - Carolette Norwood
- Department of Sociology and Criminology, Howard University, Washington, DC, USA
| | - Alison H. Norris
- Division of Epidemiology, The Ohio State University, College of Public Health, Columbus, OH, USA
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Kaufman R, Brown R, Martínez Coral C, Jacob J, Onyango M, Thomasen K. Global impacts of Dobbs v. Jackson Women’s Health Organization and abortion regression in the United States. Sex Reprod Health Matters 2022; 30:2135574. [PMID: 36383177 PMCID: PMC9673802 DOI: 10.1080/26410397.2022.2135574] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Risa Kaufman
- Director of U.S. Human Rights, Center for Reproductive Rights, New York, NY, USA. Correspondence:
| | - Rebecca Brown
- Senior Director of Global Advocacy, Center for Reproductive Rights, New York, NY, USA
| | - Catalina Martínez Coral
- Senior Regional Director for Latin America and Caribbean, Center for Reproductive Rights, Bogota, Colombia
| | - Jihan Jacob
- Senior Legal Advisor for Asia, Center for Reproductive Rights, Manila, Philippines
| | - Martin Onyango
- Associate Director, Legal Strategies, Africa, Center for Reproductive Rights, Nairobi, Kenya
| | - Katrine Thomasen
- Associate Director for Europe, Center for Reproductive Rights, Geneva, Switzerland
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Räsänen J, Gothreau C, Lippert-Rasmussen K. Does overruling Roe discriminate against women (of colour)? JOURNAL OF MEDICAL ETHICS 2022; 48:952-956. [PMID: 36180204 DOI: 10.1136/jme-2022-108504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/16/2022] [Indexed: 06/16/2023]
Abstract
On 24 July 2022, the landmark decision Roe v. Wade (1973), that secured a right to abortion for decades, was overruled by the US Supreme Court. The Court decision in Dobbs v. Jackson Women's Health Organisation severely restricts access to legal abortion care in the USA, since it will give the states the power to ban abortion. It has been claimed that overruling Roe will have disproportionate impacts on women of color and that restricting access to abortion contributes to or amounts to structural racism. In this paper, we consider whether restricting abortion access as a consequence of overruling Roe could be understood as discrimination against women of color (and women in general). We argue that banning abortion is indirectly discriminatory against women of color and directly (but neither indirectly, nor structurally) discriminatory against women in general.
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Affiliation(s)
- Joona Räsänen
- CEPDISC - Centre for the Experimental-Philosophical Study of Discrimination, Department of Political Science, Aarhus University, Aarhus, Denmark
| | - Claire Gothreau
- CEPDISC - Centre for the Experimental-Philosophical Study of Discrimination, Department of Political Science, Aarhus University, Aarhus, Denmark
| | - Kasper Lippert-Rasmussen
- CEPDISC - Centre for the Experimental-Philosophical Study of Discrimination, Department of Political Science, Aarhus University, Aarhus, Denmark
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Calkin S, Freeman C, Moore F. The geography of abortion: Discourse, spatiality and mobility. PROGRESS IN HUMAN GEOGRAPHY 2022; 46:1413-1430. [PMID: 36310819 PMCID: PMC9597139 DOI: 10.1177/03091325221128885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Abortion has historically been ignored in geography. Although bodies and pregnancy have been increasingly studied since the 1990s, a reticence around abortion remains. In recent years, however, this has begun to change. This article critically reviews how geographers and other scholars are now considering abortion and uses three conceptual lenses of discourse, spatiality and mobility to argue that abortion should be a mainstream topic of critical concern for geographers. Through these themes we show that geographical attention to abortion makes questions of space, power, and citizenship visible in new ways and, furthermore, in ways that are only recently possible.
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Affiliation(s)
- Sydney Calkin
- School of Geography, Queen Mary University of London, London, UK
| | | | - Francesca Moore
- Homerton College and Department of Geography, University of Cambridge, Cambridge, Cambridgeshire, UK
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Casas RS, Horvath SK, Schwarz EB, Bachorik AE, Chuang CC. Managing Undesired Pregnancy After Dobbs. J Gen Intern Med 2022; 37:4272-4275. [PMID: 36220947 PMCID: PMC9553298 DOI: 10.1007/s11606-022-07833-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 09/26/2022] [Indexed: 01/04/2023]
Abstract
Although both medication abortion (MAB) and aspiration procedures are safe and effective, the Supreme Court decision in Dobbs v. Jackson Women's Health Organization removed federal protection of access to abortion services. Abortion access is now illegal or severely limited in many states, leading to delays in abortion care for patients in all states. In this rapidly evolving landscape, primary care physicians (PCPs) must be familiar with laws surrounding abortion care in their own and neighboring states. PCPs must also be prepared to expedite abortion care by sharing resources, obtaining testing when needed, and counseling patients about expected outcomes following abortion.
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Affiliation(s)
- Rachel S Casas
- Division of General Internal Medicine, Department of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, USA.
| | - Sarah K Horvath
- Department of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Hershey, USA
| | - Eleanor Bimla Schwarz
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco at Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, USA
| | - Alexandra E Bachorik
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, USA
| | - Cynthia C Chuang
- Division of General Internal Medicine, Department of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, USA
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McCOURT ALEXANDERD, WHITE SARAHA, BANDARA SACHINI, SCHALL THEO, GOODMAN DAISYJ, PATEL ESITA, McGINTY EMMAE. Development and Implementation of State and Federal Child Welfare Laws Related to Drug Use in Pregnancy. Milbank Q 2022; 100:1076-1120. [PMID: 36510665 PMCID: PMC9836249 DOI: 10.1111/1468-0009.12591] [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: 01/06/2022] [Revised: 07/01/2022] [Accepted: 07/07/2022] [Indexed: 12/15/2022] Open
Abstract
Policy Points Over the past several decades, states have adopted policies intended to address prenatal drug use. Many of these policies have utilized existing child welfare mechanisms despite potential adverse effects. Recent federal policy changes were intended to facilitate care for substance-exposed infants and their families, but state uptake has been incomplete. Using legal mapping and qualitative interviews, we examine the development of state child welfare laws related to substance use in pregnancy from 1974 to 2019, with a particular focus on laws adopted between 2009 and 2019. Our findings reveal policies that may disincentivize treatment-seeking and widespread implementation challenges, suggesting a need for new treatment-oriented policies and refined state and federal guidance. CONTEXT Amid increasing drug use among pregnant individuals, legislators have pursued policies intended to reduce substance use during pregnancy. Many states have utilized child welfare mechanisms despite evidence that these policies might disincentivize treatment-seeking. Recent federal changes were intended to facilitate care for substance-exposed infants and their families, but implementation of these changes at the state level has been slowed and complicated by existing state policies. We seek to provide a timeline of state child welfare laws related to prenatal drug use and describe stakeholder perceptions of implementation. METHODS We catalogued child welfare laws related to prenatal drug use, including laws that defined child abuse and neglect and established child welfare reporting standards, for all 50 states and the District of Columbia (DC), from 1974 to 2019. In the 19 states that changed relevant laws between 2009 and 2019, qualitative interviews were conducted with stakeholders to capture state-level perspectives on policy implementation. FINDINGS Twenty-four states and DC have passed laws classifying prenatal drug use as child abuse or neglect. Thirty-seven states and DC mandate reporting of suspected prenatal drug use to the state. Qualitative findings suggested variation in implementation within and across states between 2009 and 2019 and revealed that implementation of changes to federal law during that decade, intended to encourage states to provide comprehensive social services and linkages to evidence-based care to drug-exposed infants and their families, has been complicated by existing policies and a lack of guidance for practitioners. CONCLUSIONS Many states have enacted laws that may disincentivize treatment-seeking among pregnant people who use drugs and lead to family separation. To craft effective state laws and support their implementation, state policymakers and practitioners could benefit from a treatment-oriented approach to prenatal substance use and additional state and federal guidance.
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Affiliation(s)
- ALEXANDER D. McCOURT
- Johns Hopkins University Bloomberg School of Public HealthBaltimoreMarylandUnited States
| | - SARAH A. WHITE
- Johns Hopkins University Bloomberg School of Public HealthBaltimoreMarylandUnited States
| | - SACHINI BANDARA
- Johns Hopkins University Bloomberg School of Public HealthBaltimoreMarylandUnited States
| | - THEO SCHALL
- Johns Hopkins University Bloomberg School of Public HealthBaltimoreMarylandUnited States
| | - DAISY J. GOODMAN
- Dartmouth Geisel School of Medicine, The Dartmouth Institute for Health Policy and Clinical PracticeHanoverNew HampshireUnited States
| | - ESITA PATEL
- Johns Hopkins University Bloomberg School of Public HealthBaltimoreMarylandUnited States
| | - EMMA E. McGINTY
- Division of Health Policy and EconomicsDepartment of Population Health SciencesWeill Cornell MedicineNew York, New YorkUnited States
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40
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Buchbinder M, Mishtal J, Singer EO, Wendland CL. Society for Medical Anthropology Statement on Supreme Court Dobbs v. Jackson Women's Health Organization Decision. Med Anthropol Q 2022; 36:433-441. [PMID: 36433774 PMCID: PMC10098746 DOI: 10.1111/maq.12741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This statement summarizes key findings from anthropological and related scholarship on the harmful consequences of inadequate abortion access, leading the Society for Medical Anthropology to register profound concern about the recent Supreme Court decision in Dobbs v. Jackson. After circulation to SMA members for input, a finalized version passed a membership vote by an overwhelming margin. This statement complements one produced by the Council for Anthropology and Reproduction, available here.
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Affiliation(s)
- Mara Buchbinder
- University of North Carolina at Chapel Hill, Department of Social Medicine
| | - Joanna Mishtal
- University of Central Florida, Department of Anthropology
| | | | - Claire L Wendland
- University of Wisconsin-Madison, Departments of Anthropology and Obstetrics and Gynecology
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41
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Afraid to Seek Care? A fixed effects analysis of State Fetal Protection Legislation and prenatal healthcare utilization from 2002 to 2015. SSM Popul Health 2022; 20:101273. [DOI: 10.1016/j.ssmph.2022.101273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 09/18/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022] Open
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Lowell AF, Yatziv T, Peacock-Chambers E, Zayde A, DeCoste C, Suchman N, McMahon TJ. Reflective functioning in mothers with addictions: Differential relationships involving family history of mental illness and substance use. Front Psychol 2022; 13:911069. [PMID: 36312152 PMCID: PMC9614557 DOI: 10.3389/fpsyg.2022.911069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/05/2022] [Indexed: 11/13/2022] Open
Abstract
Parental reflective functioning (RF) is often cited as an important domain in which mothers with addictions struggle in their roles as parents, though the links between addiction and RF remain unclear. Exposure to attachment trauma associated with parental mental illness and substance use is commonly associated with both addiction and lower RF. We thus examined how family history of parental mental illness and substance use may relate to the RF of mothers with addictions. One hundred ninety-four mothers in outpatient substance use treatment completed the Parent Development Interview and provided information about whether their mothers and fathers experienced mental illness or problems with substance use. Univariate ANOVAs revealed an interaction between family history of maternal mental illness and maternal substance use. Among mothers with a history of maternal substance use, those with a history of maternal mental illness had higher RF than those who had no history of maternal mental illness. Among mothers who did not report a family history of maternal mental illness, mothers who had a family history of maternal substance use exhibited significantly lower RF than mothers with no family history of maternal substance use. Exposure to paternal mental illness or substance use was not associated with mothers’ RF. These findings highlight the importance of disentangling the contributions of attachment trauma to mothers’ RF and utilizing interventions that support mothers’ capacity to reflect about how their early experiences of being cared for by a mother with a mental illness or addiction may impact their current caregiving behaviors.
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Affiliation(s)
- Amanda F. Lowell
- Child Study Center, School of Medicine, Yale University, New Haven, CT, United States
- *Correspondence: Amanda F. Lowell,
| | - Tal Yatziv
- Child Study Center, School of Medicine, Yale University, New Haven, CT, United States
| | - Elizabeth Peacock-Chambers
- Department of Pediatrics, University of Massachusetts Chan Medical School-Baystate, Springfield, MA, United States
| | - Amanda Zayde
- Montefiore Medical Center, Bronx, NY, United States
- Albert Einstein College of Medicine, New York, NY, United States
| | - Cindy DeCoste
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, United States
| | - Nancy Suchman
- Child Study Center, School of Medicine, Yale University, New Haven, CT, United States
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, United States
| | - Thomas J. McMahon
- Child Study Center, School of Medicine, Yale University, New Haven, CT, United States
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, United States
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Kulczycki A. Dobbs: Navigating the New Quagmire and Its Impacts on Abortion and Reproductive Health Care. HEALTH EDUCATION & BEHAVIOR 2022; 49:924-928. [PMID: 36173003 DOI: 10.1177/10901981221125430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
On June 24, 2022, the U.S. Supreme Court issued its decision on Dobbs v. Jackson Women's Health Organization. By voting to uphold Mississippi's law banning most abortions after 15 weeks, the Court overturned Roe v. Wade, eliminating the federal standard protecting a woman's right to abortion and reversing nearly 50 years of legal precedent. The ruling returned regulation of abortion to the states, which are responding by implementing bans or protecting access to abortion. As political and legal conflicts escalate and individual horror stories emerge, the dangerous mirage presented by this misguided legal fix to a long-standing vexing issue will come into sharper relief. The Dobbs ruling is creating a new uncertain and treacherous landscape for women and health care professionals to navigate.
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Kimport K. Abortion after Dobbs: Defendants, denials, and delays. SCIENCE ADVANCES 2022; 8:eade5327. [PMID: 36070372 PMCID: PMC9451164 DOI: 10.1126/sciadv.ade5327] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 08/22/2022] [Indexed: 06/15/2023]
Abstract
The U.S. Supreme Court's Dobbs decision will lead to more criminalization of activities during pregnancy, more abortion denials, and more abortions after the first trimester.
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Affiliation(s)
- Katrina Kimport
- ANSIRH (Advancing New Standards in Reproductive Health), University of California San Francisco, San Francisco, CA, USA.
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45
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Paltrow LM, Harris LH, Marshall MF. Beyond Abortion: The Consequences of Overturning Roe. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2022; 22:3-15. [PMID: 35652910 DOI: 10.1080/15265161.2022.2075965] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The upcoming U.S. Supreme Court decision in Dobbs v. Jackson Women's Health Organization has the potential to eliminate or severely restrict access to legal abortion care in the United States. We address the impact that the decision could have on abortion access and its consequences beyond abortion care. We posit that an abortion ban would, in effect, mean that anyone who becomes pregnant, including those who continue a pregnancy and give birth to healthy newborns and those with pregnancy complications or adverse pregnancy outcomes will become newly vulnerable to legal surveillance, civil detentions, forced interventions, and criminal prosecution. The harms imposed by banning or severely restricting abortion access will disproportionately affect persons of color and perpetuate structural racism. We caution that focusing on Roe as a decision that only protects ending a pregnancy ignores the protection that the decision also affords people who want to continue their pregnancies. It overlooks the ways in which overturning Roe will curtail fundamental rights for all those who become pregnant and will undermine their status as full persons meriting Constitutional protections. Such a singular focus inevitably obscures the common ground that people across the ideological spectrum might inhabit to ensure the safety, health, humanity, and rights of all people who experience pregnancy.
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46
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Michie M. Beyond Abortion Clinics: How Overturning Roe Will Obstruct Life-Saving Research and Fetal Therapy. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2022; 22:62-64. [PMID: 35917428 PMCID: PMC9721389 DOI: 10.1080/15265161.2022.2089278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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King Z, Lyerly AD, Knittel AK. Safekeeping of Pregnant People Experiencing Incarceration. WOMEN & CRIMINAL JUSTICE 2022; 33:363-377. [PMID: 37789904 PMCID: PMC10545335 DOI: 10.1080/08974454.2022.2104986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Safekeeping involves transferring individuals from jails to prisons without the presence of a conviction. In North Carolina, safekeeping is used for pregnant people with the aim of providing better prenatal care. We interviewed 14 stakeholders in the safekeeping process including sheriffs, clinicians, advocates, and lawyers. Three key themes emerged: jails' inability to provide care for pregnant individuals; safekeeping as an additional punishment to incarceration; and differing attitudes on the necessity of safekeeping. Participants perceived that while there may be some benefits of safekeeping such as enhanced prenatal care, safekeeping can also lead to worsened conditions for pregnant people experiencing incarceration.
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Affiliation(s)
- Zoe King
- Duke University, Trinity College of Arts & Sciences; 117 Physics Building; 120 Science Dr.; Durham, NC 27708; United States
| | - Anne D. Lyerly
- University of North Carolina at Chapel Hill School of Medicine, Department of Social Medicine, 333 South Columbia St, 333 MacNider Hall, CB# 7240, Chapel Hill, NC 27599; United States
| | - Andrea K. Knittel
- University of North Carolina at Chapel Hill Department of Obstetrics and Gynecology; 3027 Old Clinic Building, CB#7570, Chapel Hill, NC 27599
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48
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Harris LH. Navigating Loss of Abortion Services - A Large Academic Medical Center Prepares for the Overturn of Roe v. Wade. N Engl J Med 2022; 386:2061-2064. [PMID: 35544368 DOI: 10.1056/nejmp2206246] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Lisa H Harris
- From the Departments of Obstetrics and Gynecology and Women's and Gender Studies, University of Michigan, Ann Arbor
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McCabe K. Criminalization of Care: Drug Testing Pregnant Patients. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2022; 63:162-176. [PMID: 34794355 DOI: 10.1177/00221465211058152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This article reveals how law and legal interests transform medicine. Drawing on qualitative interviews with medical professionals, this study shows how providers mobilize law and engage in investigatory work as they deliver care. Using the case of drug testing pregnant patients, I examine three mechanisms by which medico-legal hybridity occurs in clinical settings. The first mechanism, clinicalization, describes how forensic tools and methods are cast in clinical terminology, effectively cloaking their forensic intent. In the second, medical professionals informally rank the riskiness of illicit substances using both medical and criminal-legal assessments. The third mechanism describes how gender, race, and class inform forensic decision-making and criminal suspicion in maternal health. The findings show that by straddling both medical and legal domains, medicine conforms to the standards and norms of neither institution while also suspending meaningful rights for patients seeking care.
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Pregnant and Postpartum People with Substance Use Disorders: Understanding the Obstetrical Care Provider' s Roles and Responsibilities. Matern Child Health J 2022; 26:1409-1414. [PMID: 35596847 DOI: 10.1007/s10995-022-03446-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] [Received: 03/11/2021] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 10/18/2022]
Abstract
Peripartum individuals with substance misuse are a high-risk population that challenge clinicians and child welfare specialists alike. Federal legislation was updated in 2016 with the Comprehensive Addiction Recovery Act (CARA) to improve care via expanded screening and treatment referrals for peripartum women with substance misuse. The implementation of CARA requires providers to update their policies and procedures in order to meet the requirements outlined by this legislation. As this is a new process, this paper reviews the new administrative reporting and safety planning requirements relevant to obstetrical care providers and provides examples of best practice for different clinical scenarios. Given the variable state laws, confidentiality concerns, influence of stigma and health inequities on substance use treatment, and the fragmented healthcare system, implementation of CARA will challenge obstetric, pediatric, and mental health care providers along with child welfare services. All entities involved must work together to create effective and efficient protocols to address the CARA requirements. Health systems must also evaluate and update methods and interventions to assure that policies improve family stability and well-being.
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