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Seymour JW, Goode BA, Guerrero P, Campos AM, Kyles K, Dreyfus-Pai P, Baum SE. Emotional, informational, and decision-making support needs among people seeking abortion in the US: perspectives from All-Options Talkline callers. Sex Reprod Health Matters 2023; 31:2248742. [PMID: 37728428 PMCID: PMC10512898 DOI: 10.1080/26410397.2023.2248742] [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: 09/21/2023] Open
Abstract
People seeking abortion may need or want emotional or informational support before, during, and after their abortion. Feeling supported and affirmed contributes to perceptions of quality care. The All-Options Talkline offers free, telephone-based, peer counselling to callers anywhere in the United States. This study aimed to explore the types of support received through the Talkline and the ways it supplemented other forms of support received by people who obtained an abortion. Between May 2021 and February 2022, we conducted 30 interviews via telephone or Zoom with callers recruited through the Talkline. We coded the interviews and conducted thematic analysis, focusing on themes related to gaps of support from family, friends, and healthcare professionals, as well as types of support received through the Talkline. We identified four key motivations for calling the Talkline, including the need for (1) decision-making support and validation, (2) a neutral perspective, (3) emotional support to discuss negative or complex feelings, and (4) information about the abortion process. Participants indicated that interactions with family, friends, and healthcare professionals ranged from unsupportive and negative, to substantially supportive. Access to the Talkline was particularly useful prior to clinical interactions and in the weeks or months after an abortion. We found that the All-Options Talkline provided person-centred, remote support for callers, filling gaps or supplementing support from one's community or healthcare professionals. Abortion support from non-medically trained support people contributes to high-quality abortion care, especially in a time of increasing abortion restrictions and use of remote abortion services.
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Affiliation(s)
- Jane W. Seymour
- Research Scientist, Collaborative for Reproductive Equity (CORE), Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin, Madison
| | - Bria A. Goode
- Senior Research Manager, Ibis Reproductive Health, Oakland, CA, USA
| | | | | | - Kai Kyles
- Project Coordinator, All-Options, Cleveland, OH, USA
| | | | - Sarah E. Baum
- Senior Research Scientist, Ibis Reproductive Health, Oakland, CA, USA
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2
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Reardon DC, Rafferty KA, Longbons T. The Effects of Abortion Decision Rightness and Decision Type on Women's Satisfaction and Mental Health. Cureus 2023; 15:e38882. [PMID: 37303450 PMCID: PMC10257365 DOI: 10.7759/cureus.38882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2023] [Indexed: 06/13/2023] Open
Abstract
Background A case series report based on the Turnaway Study has previously concluded that 99% of women with a history of abortion will continue to affirm satisfaction with their decisions to abort. Those findings have been called into question due to a low participation rate (31%) and reliance on a single yes/no assessment of decision satisfaction. Aim To utilize more sensitive scales in assessing decision satisfaction and the associated mental health outcomes women attribute to their abortions. Method A retrospective survey was completed by 1,000 females, aged 41-45, living in the United States. The survey instrument included 11 visual analog scales for respondents to rate their personal preferences and outcomes they attributed to their abortion decisions. A categorical question allowed women to identify if their abortions were wanted and consistent with their own values and preferences, inconsistent with their values and preferences, unwanted, or coerced. Linear regression models were tested to identify which of three decision scales best predicted positive or negative emotions, effects on mental health, emotional attachment, personal preferences, moral conflict, and other factors relevant to an assessment of satisfaction with a decision to abort. Results Of 226 women reporting a history of abortion, 33% identified it as wanted, 43% as accepted but inconsistent with their values and preferences, and 24% as unwanted or coerced. Only wanted abortions were associated with positive emotions or mental health gains. All other groups attributed more negative emotions and mental health outcomes to their abortions. Sixty percent reported they would have preferred to give birth if they had received more support from others or had more financial security. Conclusions Perceived pressure to abort is strongly associated with women attributing more negative mental health outcomes to their abortions. The one-third of women for whom abortion is wanted and consistent with their values and preferences are most likely over-represented in studies initiated at abortion clinics. More research is needed to understand better the experience of the two-thirds of women for whom abortion is unwanted, coerced, or otherwise inconsistent with their own values and preferences.
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Affiliation(s)
- David C Reardon
- Research, Elliot Institute, St. Peters, USA
- Research, Charlotte Lozier Institute, Arlington, USA
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3
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Ratcliffe SE, Smylie CS, Pinkus RT, Dar-Nimrod I, Juraskova I, Dhillon HM. What is the optimal tool for measuring abortion stigma? A systematic review. EUR J CONTRACEP REPR 2023; 28:97-112. [PMID: 36803281 DOI: 10.1080/13625187.2023.2177506] [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: 02/22/2023]
Abstract
PURPOSE Abortion stigma is a barrier to accessing and delivering comprehensive, sustainable healthcare. This study aimed to systematically identify measures of abortion stigma, and assess their psychometric properties and uses. MATERIALS AND METHODS The systematic review was preregistered with PROSPERO (ID#127339) and adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eight databases were screened for articles measuring abortion stigma. Data were extracted by four researchers and checked for accuracy by two reviewers. Psychometric properties were assessed with COSMIN guidelines. RESULTS Of 102 articles reviewed, 21 reported original measures of abortion stigma. Instruments assessed individual and community level stigma for people who have had an abortion (n = 8), healthcare professionals (n = 4), and the public (n = 9), and predominantly originated from the United States (U.S.). Measures varied in structure, use, and comprehensiveness of psychometric properties. On psychometric properties, the Individual Level Abortion Stigma scale and Abortion Provider Stigma Scale - Revised performed best for individual-level stigma and the Stigmatising Attitudes, Beliefs and Actions Scale for community-level stigma. CONCLUSION Gaps in abortion stigma measurement include geography, conceptualisation, and structural-level stigma. Continued development and testing of tools and methods for measuring abortion stigma is needed.
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Affiliation(s)
- Sarah E Ratcliffe
- School of Psychology, Centre for Medical Psychology & Evidence-based Decision-Making, The University of Sydney, Sydney, Australia.,School of Psychology, Faculty of Science, The University of Sydney, Camperdown, Australia
| | - Clare S Smylie
- School of Psychology, Faculty of Science, The University of Sydney, Camperdown, Australia
| | - Rebecca T Pinkus
- School of Psychology, Faculty of Science, The University of Sydney, Camperdown, Australia
| | - Ilan Dar-Nimrod
- School of Psychology, Faculty of Science, The University of Sydney, Camperdown, Australia.,The Charles Perkins Centre, University of Sydney, John Hopkins Dr, Camperdown, Australia
| | - Ilona Juraskova
- School of Psychology, Centre for Medical Psychology & Evidence-based Decision-Making, The University of Sydney, Sydney, Australia.,School of Psychology, Faculty of Science, The University of Sydney, Camperdown, Australia
| | - Haryana M Dhillon
- School of Psychology, Centre for Medical Psychology & Evidence-based Decision-Making, The University of Sydney, Sydney, Australia.,School of Psychology, Faculty of Science, The University of Sydney, Camperdown, Australia
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4
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Makenzius M, Obern C, Tydén T, Larsson M, Gemzell-Danielsson K, Sundström-Poromaa I, Ekstrand Ragnar M. Women's decision-making related to induced abortion - a cross sectional study during a period of Covid-19 pandemic, in Sweden. EUR J CONTRACEP REPR 2023; 28:44-50. [PMID: 36459054 DOI: 10.1080/13625187.2022.2150047] [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: 12/04/2022]
Abstract
OBJECTIVES To investigate women's decision-making on induced abortion. MATERIALS AND METHODS A multi-centre cross-sectional survey among 623 abortion-seeking women in Sweden (2021). The perceived difficulty to decide on abortion was measured using a 7-point Likert scale, and analysed with univariate and multivariate analysis (odds ratios [OR], 95% confidence intervals [CI]). RESULTS About half (n = 322;52%) scored 1-4, suggesting the decision was perceived as easier compared to those (n = 292;48%) who scored 5-7. Reasons for the abortion were: poor economy (n = 166;27%), too early in the relationship (n = 154;25.1%), want to work first (n = 147;23.9%), want to study first (n = 132;21.5%), uncertain about the relationship (104;16.9%), and too young (n = 104;16.9%). Predictors for perceiving the decision as difficult: partner's hesitance (OR = 3.18, CI:1.76-5.73), being born outside the Nordic countries (OR = 2.23, CI:1.28-3.87), having discussed the decision with someone (OR = 2.42, CI:1.67-3.50), age ≥30 (OR = 2.22, CI:1.03-4.76), the Covid-19 pandemic (OR = 2.08, CI:1.20-3.59), and the desire to have children in the future (OR = 1.96, CI:1.18-3.28). After confirmed pregnancy, poor mental well-being was more common among those who scored 5-7 (n = 140;47.9%) compared to those who scored 1-4 (n = 122;37.9), p = .029. CONCLUSION Women's decision-making on abortion is complex; in times of crises, the decision procedure may be even more difficult. This valuable knowledge could be used to improve and promote satisfactory counselling beyond medical routines.
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Affiliation(s)
- M Makenzius
- Department of Health Care Sciences, Mid Sweden University, Östersund, Sweden.,Department of Global Public Health, Karolinska institutet, Stockholm, Sweden
| | - C Obern
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - T Tydén
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - M Larsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - K Gemzell-Danielsson
- Department of Women's and Children's Health, Karolinska University Hospital, Karolinska institutet, Stockholm, Sweden
| | - I Sundström-Poromaa
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - M Ekstrand Ragnar
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Health Sciences, Lund University, Lund, Sweden
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5
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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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6
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Rajkumar RP. The Relationship Between Access to Abortion and Mental Health in Women of Childbearing Age: Analyses of Data From the Global Burden of Disease Studies. Cureus 2022; 14:e31433. [DOI: 10.7759/cureus.31433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2022] [Indexed: 11/14/2022] Open
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7
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Rich N, Rapkin R. Upholding Medical Ethics Principles by Performing Abortion: A Provider's Perspective. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2022.0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Natasha Rich
- Postgraduate year 3, Department of Obstetrics and Gynecology, University of South Florida, Tampa, Florida, USA
| | - Rachel Rapkin
- Ryan Program, Division of Specialists in Obstetrics/Gynecology, Department of Obstetrics and Gynecology, University of South Florida, Tampa, Florida, USA
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8
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Disi ES, Okpaise OO, Akpanobong MAU, Eyinfunjowo SO, Ukwandu SA, Alabintei MO. Effects and Proposed Countermeasures of Abortion Bans and Restrictions on People With Uteruses and Society. Cureus 2022; 14:e29906. [PMID: 36348848 PMCID: PMC9632542 DOI: 10.7759/cureus.29906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2022] [Indexed: 01/24/2023] Open
Abstract
With the recent overturning of Roe V. Wade by the Supreme Court, access to abortions in many regions across the United States will become very limited as laws regarding fetal termination will be determined by state legislators rather than on a federal level. This article highlights the effects of Roe V. Wade's abolishment on individuals that can get pregnant, how unwanted pregnancies will affect society in general, and reasonable steps forward following the ban. We conducted an electronic search using PubMed, Google, and Google Scholar. The search was retrospective, and the preliminary results focused on articles about the rationale behind pregnancy termination and the overall effects of abortion and the ban. Review papers, original papers, and newspaper articles were eligible for use. Sample size and region of publication were not exclusionary criteria. Each author independently reviewed and extracted data to write up each assigned section, and group collaborations occurred to create the final draft. Out of the 93 resources reviewed, 32 sources were deemed eligible and used in this article. These resources included 23 journal articles, eight websites, and one book.. The data gathered showed that while abortions have many potential complications even when performed under regulated conditions, taking away the choice of those with a uterus is also not without consequence. The economic, familial, and societal implications should be considered moving forward as safety nets will need to be implemented for people with uterus and children involved.
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Affiliation(s)
- Efe S Disi
- College of Medicine, Madonna University, Elele, NGA
- Biology, University of Kentucky, Lexington, USA
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9
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Hooberman L, Ozoguz S. Abortion, mental health and epistemologies of psychological knowledge and ignorance. SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2022. [DOI: 10.1111/spc3.12703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Laura Hooberman
- Department of Psychology The CUNY Graduate Center New York New York USA
| | - Sedef Ozoguz
- Department of Psychology The CUNY Graduate Center New York New York USA
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10
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Affiliation(s)
- M Antonia Biggs
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
| | - Corinne Rocca
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
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11
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Wang N, Zhu X, Gamble J, Elder E, Allen J, Creedy DK. The STress-And-Coping suppoRT Intervention (START) for Chinese Women Undergoing Abortion: A Randomized Controlled Trial Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116611. [PMID: 35682201 PMCID: PMC9180830 DOI: 10.3390/ijerph19116611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 02/01/2023]
Abstract
Background: Although undergoing an abortion is stressful for most women, little attention has been given to their psychological wellbeing. This protocol aims to assess the feasibility, acceptability, and primary effects of a complex intervention to promote positive coping behaviors and alleviate depression symptoms among Chinese women who have undergone an abortion. Methods: A two-arm randomized controlled trial design will be used. Participants will be recruited at their first appointment with the abortion clinic and randomly allocated to receive either the Stress-And-Coping suppoRT (START) intervention (in addition to standard abortion care) or standard care only. All participants will be followed-up at two- and six-weeks post-abortion. Approval has been granted by local and university ethics committees. This research was supported by an Australian Government Research Training Program Scholarship. Discussion: The results will assist refinement and further evaluations of the START intervention, contribute to improved abortion care practices in China, and enrich the evidence on improving women’s psychological well-being following abortion in China. Trial registration: Registered at the Chinese Clinical Trials.gov: ChiCTR2100046101. Date of registration: 4 May 2021.
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Affiliation(s)
- Na Wang
- School of Nursing and Midwifery, Gold Coast Campus, Griffith University, Parklands Drive, Gold Coast, QLD 4215, Australia; (N.W.); (E.E.)
- School of Nursing, Capital Medical University, 10 Xitoutiao Road, Fengtai District, Beijing 100069, China
| | - Xiu Zhu
- School of Nursing, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China
- Correspondence:
| | - Jenny Gamble
- School of Nursing and Midwifery, Logan Campus, Griffith University, University Drive, Meadowbrook, Brisbane, QLD 4131, Australia; (J.G.); (J.A.); (D.K.C.)
| | - Elizabeth Elder
- School of Nursing and Midwifery, Gold Coast Campus, Griffith University, Parklands Drive, Gold Coast, QLD 4215, Australia; (N.W.); (E.E.)
| | - Jyai Allen
- School of Nursing and Midwifery, Logan Campus, Griffith University, University Drive, Meadowbrook, Brisbane, QLD 4131, Australia; (J.G.); (J.A.); (D.K.C.)
| | - Debra K. Creedy
- School of Nursing and Midwifery, Logan Campus, Griffith University, University Drive, Meadowbrook, Brisbane, QLD 4131, Australia; (J.G.); (J.A.); (D.K.C.)
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12
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McQuade M, Reddy N, Barbour K, Owens L. Integrating reproductive health care into substance use disorder services. Int Rev Psychiatry 2021; 33:572-578. [PMID: 33974476 DOI: 10.1080/09540261.2021.1904845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
People who use drugs face layered stigma and barriers to accessing reproductive health care services. At the same time, they have unique needs for compassionate, trauma-informed, low-barrier reproductive health care. We review the literature on collocated reproductive health care and substance use treatment services in this population and advocate for expansion of reproductive health care services at sites providing care for substance use disorder. Through this review article, we outline the evidence for and best practices in collocating reproductive health care within substance use disorder services.
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Affiliation(s)
- Miriam McQuade
- Department of Obstetrics and Gynecology, University of Rochester, Rochester, NY, USA
| | - Neha Reddy
- The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Kyle Barbour
- Department of Emergency Medicine, University of Rochester, Rochester, NY, USA
| | - Lauren Owens
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
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13
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Zia Y, Mugo N, Ngure K, Odoyo J, Casmir E, Ayiera E, Bukusi E, Heffron R. Psychosocial Experiences of Adolescent Girls and Young Women Subsequent to an Abortion in Sub-saharan Africa and Globally: A Systematic Review. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:638013. [PMID: 36303958 PMCID: PMC9580653 DOI: 10.3389/frph.2021.638013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/22/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction: Unmet need for contraception, unintended pregnancy, and access to safe abortion remain global challenges preventing adolescent girls and young women (AGYW) from achieving optimal reproductive health. Furthermore, AGYW face difficulties navigating sexual autonomy, lack of agency or experience negotiating sexual acts, and challenges accessing sexual health information and services. The aim of this systematic review is to assess the psychosocial outcomes of AGYW who have experienced an abortion with particular focus on sub-Saharan Africa, which bears the global burden of unintended pregnancy and risk of death due to unsafe abortion. Materials and Methods: The systematic review was registered and used search terms to identify peer-reviewed articles relevant to "post-abortion," "psychosocial," "adolescent girls," and "young women" from PubMed, Embase, PsycInfo, and Cumulative Index to Nursing and Allied Health Literature. Examples of psychosocial experiences include quality of life, stigma, and mental health outcomes. Rayyan software (Qatar, 2020) was used by two reviewers to assess the relevance of each article to psychosocial outcomes of AGYW any time after an abortion or accessing post-abortion services. Analysis was conducted with a focus on data from Africa and comparisons are made to non-African settings. Results: A total of 2,406 articles were identified and 38 articles fit the criteria. Six selected articles were from Africa, including Ghana, Kenya, Uganda, and Zambia, and the remaining articles were from other regions. Themes around stigma, shame, and abandonment associated with the experience of abortion were prevalent in all regions. Studies of psychosocial outcomes of AGYW in sub-Saharan Africa highlight social isolation as well as learned resilience among young women who abort. Discussion: Navigating abortion as an AGYW involves managing internalized and perceived stigma, fear of violence, secrecy, and growing resilient in order to overcome the significant barriers that society and culture place on access to an essential service in sexual and reproductive health. Post-abortion psychosocial outcomes highlight the need for support services and investigation of contexts that perpetuate and necessitate unsafe abortion. Empowerment of AGYW may present an important opportunity to build self-agency and positive coping mechanisms to withstand social pressures during stigmatizing circumstances associated with abortion.
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Affiliation(s)
- Yasaman Zia
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Nelly Mugo
- Department of Global Health, University of Washington, Seattle, WA, United States
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Kenneth Ngure
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Community Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Josephine Odoyo
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Edinah Casmir
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Elizabeth Bukusi
- Department of Global Health, University of Washington, Seattle, WA, United States
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
| | - Renee Heffron
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Epidemiology, University of Washington, Seattle, WA, United States
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14
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Sansone A, Limoncin E, Colonnello E, Mollaioli D, Ciocca G, Corona G, Jannini EA. Harm Reduction in Sexual Medicine. Sex Med Rev 2021; 10:3-22. [DOI: 10.1016/j.sxmr.2021.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 01/21/2021] [Accepted: 01/24/2021] [Indexed: 12/22/2022]
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15
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Biggs MA, Neilands TB, Kaller S, Wingo E, Ralph LJ. Developing and validating the Psychosocial Burden among people Seeking Abortion Scale (PB-SAS). PLoS One 2020; 15:e0242463. [PMID: 33301480 PMCID: PMC7728247 DOI: 10.1371/journal.pone.0242463] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 11/03/2020] [Indexed: 11/23/2022] Open
Abstract
While there is a large body of research demonstrating that having an abortion is not associated with adverse mental health outcomes, less research has examined which factors may contribute to elevated levels of mental health symptoms at the time of abortion seeking. This study aims to develop and validate a new tool to measure dimensions of psychosocial burden experienced by people seeking abortion in the United States. To develop scale items, we reviewed the literature including existing measures of stress and anxiety and conducted interviews with experts in abortion care and with patients seeking abortion. Thirty-five items were administered to 784 people seeking abortion at four facilities located in three U.S. states. We used exploratory factor analysis (EFA) to reduce items and identify key domains of psychosocial burden. We assessed the predictive validity of the overall scale and each sub-scale, by assessing their associations with validated measures of perceived stress, anxiety, and depression using multivariable linear regression models. Factor analyses revealed a 12-item factor solution measuring psychosocial burden seeking abortion, with four subdomains: structural challenges, pregnancy decision-making, lack of autonomy, and others' reactions to the pregnancy. The alpha reliability coefficients were acceptable for the overall scale (α = 0.83) and each subscale (ranging from α = 0.82-0.85). In adjusted analyses, the overall scale was significantly associated with stress, anxiety and depression; each subscale was also significantly associated with each mental health outcome. This new scale offers a practical tool for providers and researchers to empirically document the factors associated with people's psychological well-being at the time of seeking an abortion. Findings suggest that the same restrictions that claim to protect people from mental health harm may be increasing people's psychosocial burden and contributing to adverse psychological outcomes at the time of seeking abortion.
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Affiliation(s)
- M. Antonia Biggs
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Torsten B. Neilands
- Division of Prevention Science, Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Shelly Kaller
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Erin Wingo
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Lauren J. Ralph
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America
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16
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Rocca CH, Moseson H, Gould H, Foster DG, Kimport K. Emotions over five years after denial of abortion in the United States: Contextualizing the effects of abortion denial on women's health and lives. Soc Sci Med 2020; 269:113567. [PMID: 33309441 DOI: 10.1016/j.socscimed.2020.113567] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/04/2020] [Accepted: 11/26/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Turnaway Study was the first to follow women denied abortions because of state law or facility policy over five years. The study has found negative effects on women's socioeconomic status, physical health, and on their children's wellbeing. However, women did not suffer lasting mental health consequences, prompting questions about the effects of denial on women's emotions. METHODS In this mixed methods study, we used quantitative and qualitative interview data from the Turnaway Study to offer insight into these findings. We surveyed 161 women who were denied abortions at 30 facilities across the United States between 2008 and 2010 one week after the abortion denial and semiannually over five years. Mixed-effects regression analyses examined emotions about having been denied the abortion over time. To contextualize the quantitative findings, we draw on in-depth qualitative interviews with 15 participants, conducted in 2014-2015, for their accounts of their emotions and feelings over time. RESULTS Survey participants reported both negative and positive emotions about the abortion denial one week after. Emotions became significantly less negative and more positive over their pregnancy and after childbirth. In multivariable models, lower social support, more difficulty deciding to seek abortion, and placing the baby for adoption were associated with reporting more negative emotions. Interviews revealed how, for some, belief in antiabortion narratives contributed to initial positive emotions. Subsequent positive life events and bonding with the child also led to positive retrospective evaluations of the denial. CONCLUSIONS Findings of emergent positive emotions about having been denied an abortion suggest that individuals are able to cope emotionally with an abortion denial, although evidence that policies leading to abortion denial cause significant health and socioeconomic harms remains.
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Affiliation(s)
- Corinne H Rocca
- University of California, San Francisco, School of Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, Advancing New Standards in Reproductive Health (ANSIRH), 1330 Broadway, Suite 1100, Oakland, CA, 94612, USA.
| | - Heidi Moseson
- Ibis Reproductive Health, 1736 Franklin Street, Suite 600, Oakland, CA, 94612, USA.
| | - Heather Gould
- University of California, San Francisco, School of Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, Advancing New Standards in Reproductive Health (ANSIRH), 1330 Broadway, Suite 1100, Oakland, CA, 94612, USA.
| | - Diana G Foster
- University of California, San Francisco, School of Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, Advancing New Standards in Reproductive Health (ANSIRH), 1330 Broadway, Suite 1100, Oakland, CA, 94612, USA.
| | - Katrina Kimport
- University of California, San Francisco, School of Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, Advancing New Standards in Reproductive Health (ANSIRH), 1330 Broadway, Suite 1100, Oakland, CA, 94612, USA.
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17
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Swartz JJ, Rowe C, Morse JE, Bryant AG, Stuart GS. Women's knowledge of their state's abortion regulations. A national survey. Contraception 2020; 102:318-326. [PMID: 32771370 PMCID: PMC7409738 DOI: 10.1016/j.contraception.2020.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 07/31/2020] [Accepted: 08/01/2020] [Indexed: 11/28/2022]
Abstract
Objectives States vary significantly in their regulation of abortion. Misinformation about abortion is pervasive and propagated by state-mandated scripts that contain abortion myths. We sought to investigate women’s knowledge of abortion laws in their state. Our secondary objective was to describe women’s ability to discern myths about abortion from facts about abortion. Study design This was a cross-sectional study of English- and Spanish-speaking women aged 18–49 in the United States. We enrolled members of the GfK KnowledgePanel, a probability-based, nationally-representative online sample. Our primary outcome was the proportion of correct answers to 12 questions about laws regulating abortion in a respondent’s state. We asked five questions about common abortion myths. We used descriptive statistics to characterize performance on these measures and bivariate and multivariate modeling to identify risk factors for poor knowledge of state abortion laws. Results Of 2223 women contacted, 1057 (48%) completed the survey. The mean proportion of correct answers to 12 law questions was 18% (95% CI 17–20%). For three of five assessed myths, women endorsed myths about abortion over facts. Those who believe abortion should be illegal (aOR 2.18, CI 1.40–3.37), and those living in states with neutral or hostile state policies toward abortion (neutral aOR 1.99, CI 1.34–2.97; hostile aOR 1.6, CI 1.07–2.36) were at increased odds of poor law knowledge. Conclusions Women had low levels of knowledge about state abortion laws and commonly endorse abortion myths. Women’s knowledge of their state’s abortion laws was associated with personal views about abortion and their state policy environment. Implications Supporters of reproductive rights can use these results to show policy makers that their constituents are unlikely to know about laws being passed that may profoundly affect them. These findings underscore the potential benefit in correcting widely-held, medically-inaccurate beliefs about abortion so opinions about laws can be based on fact.
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Affiliation(s)
- Jonas J Swartz
- Division of Women's Community and Population Health, Department of OB/GYN, Duke University Medical Center, Durham, NC, United States; University of North Carolina School of Medicine, Division of Family Planning, Dept of OBGYN, Chapel Hill, NC, United States.
| | - Carly Rowe
- University of North Carolina School of Medicine, Division of Family Planning, Dept of OBGYN, Chapel Hill, NC, United States
| | - Jessica E Morse
- University of North Carolina School of Medicine, Division of Family Planning, Dept of OBGYN, Chapel Hill, NC, United States
| | - Amy G Bryant
- University of North Carolina School of Medicine, Division of Family Planning, Dept of OBGYN, Chapel Hill, NC, United States
| | - Gretchen S Stuart
- University of North Carolina School of Medicine, Division of Family Planning, Dept of OBGYN, Chapel Hill, NC, United States
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18
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McCarthy MA, Upadhyay U, Ralph L, Biggs MA, Foster DG. The effect of receiving versus being denied an abortion on making and achieving aspirational 5-year life plans. BMJ SEXUAL & REPRODUCTIVE HEALTH 2020; 46:177-183. [PMID: 32098771 DOI: 10.1136/bmjsrh-2019-200456] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 12/19/2019] [Accepted: 01/20/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Popular support for access to abortion and contraceptive services is often based on the idea that they will help women determine the trajectory of their life course. This study examined whether receiving versus being denied an abortion affects aspirational life goal setting and attainment 5 years later. METHODS We compared women who sought and were denied an abortion because they were 3 weeks beyond the gestational limit ('Parenting-Turnaways') to those who received an abortion in the first trimester ('First-Trimesters'); received an abortion within 2 weeks of the facility's gestational limit ('Near-Limits'); and sought an abortion, were turned away and received an abortion elsewhere or placed their baby for adoption ('Non-Parenting-Turnaways'). We used mixed effects logistic regression analyses to estimate the odds of setting an aspirational plan and to estimate the odds of both setting and achieving an aspirational 5-year plan. RESULTS At 1 week post abortion-seeking, 791 women reported 1864 5-year plans, most of which were aspirational (n=1692, 91%). Parenting-Turnaways had lower odds of setting an aspirational 5-year plan than Near-Limits (OR 0.36, 95% CI 0.18 to 0.73). There were no differences by group in achieving aspirational 5-year plans among those who had them. CONCLUSIONS Soon after abortion-seeking, women denied a wanted abortion were less optimistic about their long-term futures than women who received a wanted abortion. Abortion access can help women set positive long-term goals.
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Affiliation(s)
- Molly A McCarthy
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Ushma Upadhyay
- University of California San Francisco (UCSF), San Francisco, California, USA
| | - Lauren Ralph
- University of California San Francisco (UCSF), San Francisco, California, USA
| | - M Antonia Biggs
- University of California San Francisco (UCSF), San Francisco, California, USA
| | - Diana Greene Foster
- Advancing New Standards in Reproductive Health (ANSIRH), UCSF, Oakland, California, USA
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19
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Danet Danet A. [Women's emotional accounts of induced abortion]. GACETA SANITARIA 2020; 35:361-373. [PMID: 32451189 DOI: 10.1016/j.gaceta.2020.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/11/2020] [Accepted: 02/14/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To explore women's emotional accounts of induced abortion, analyzing qualitative scientific publications. METHOD Qualitative systematic review of 19 studies published in PubMed, Science Direct and Scopus from 2010 onwards. The articles based on qualitative research design were revised using inductive content analysis. RESULTS The analysis identified three main themes regarding women's emotional experiences: access to abortion, emotional impact during medical assistance, and individual, relational and sociocultural determinants. The studies showed the variability in women's emotional accounts, mainly determined by the following factors: Access and waiting times, health system, type of intervention, degree of awareness and participation regarding the use of technical and medical technologies, interaction with health professionals, and specificity of individual, relational and sociocultural context. The main emotional difficulties were related to the ethical conflict, the decision-making, the relation with the social and health system and stigma. As main facilitating aspects, women highlighted autonomy in decision-making and emotional support, while barriers referred to social rejection and negative messages perceived from the political, social and health system. CONCLUSIONS The emotional accounts around induced abortion depend on individual and relational factors, as well as on health assistance, all mediated by gender inequalities and bias. Improvements in health assistance refer to an integral and individualized attention, adapted to women's needs.
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Affiliation(s)
- Alina Danet Danet
- Departamento de Organización de Empresas, Marketing y Sociología, Área de Sociología, Universidad de Jaén, Jaén, España.
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20
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Rocca CH, Wilson MR, Jeon M, Foster DG. Stability of Retrospective Pregnancy Intention Reporting Among Women with Unwanted Pregnancies in the United States. Matern Child Health J 2020; 23:1547-1555. [PMID: 31236825 DOI: 10.1007/s10995-019-02782-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives Retrospective assessment of pregnancy intention may be unreliable as women's perceptions of a past conception can change over time. We compared the stability of retrospective pregnancy intention reporting over 5 years among women who sought and either received, or were denied, an abortion. Methods We recruited women from 30 abortion facilities across the United States in 2008-2010. Participants, some who received abortions and others who were denied care because they presented beyond facilities gestational limits, were followed prospectively for 5 years (n = 827). At enrollment and semiannually from year-2 to year-5, women completed the London Measure of Unplanned Pregnancy (LMUP), a six-item measure (scored 0-12), regarding the index pregnancy. We used multivariable mixed-effects models to assess the stability of retrospective reports of index pregnancy intendedness and compared trajectories by group, accounting for site and participant clustering. Our hypotheses were that intention would tend towards "more intended" over time among women denied abortions, who carried the pregnancies to term, and remain stable among women who received the abortion. Results Baseline LMUP scores were low (mean: 2.8) and similar by study group. Scores increased among women denied the abortion by year-2 (from 2.9 to 3.5; p < 0.001) and were steady through year-5. For women having near-limit abortions, reported intentions were steady between baseline (mean: 2.7) and year-2 (2.8), and declined thereafter through year-5 (to 2.5; p < 0.001). Conclusions Women somewhat shifted their perceptions of their intentions in correspondence with the pregnancy outcome. Retrospective estimates may underestimate the degree to which births result from unintended pregnancy.
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Affiliation(s)
- Corinne H Rocca
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California, San Francisco, 1330 Broadway, 11th Floor, Oakland, CA, 94612, USA.
| | - Mark R Wilson
- Graduate School of Education, University of California, Berkeley, 4415 Berkeley Way Building, Berkeley, CA, 94720, USA
| | - Minjeong Jeon
- Graduate School of Education and Information Studies, University of California, Los Angeles, Moore Hall 3141, 405 Hilgard Avenue, Los Angeles, CA, 90095, USA
| | - Diana G Foster
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California, San Francisco, 1330 Broadway, 11th Floor, Oakland, CA, 94612, USA
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21
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Rocca CH, Samari G, Foster DG, Gould H, Kimport K. Emotions and decision rightness over five years following an abortion: An examination of decision difficulty and abortion stigma. Soc Sci Med 2020; 248:112704. [DOI: 10.1016/j.socscimed.2019.112704] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 10/23/2019] [Accepted: 11/26/2019] [Indexed: 01/26/2023]
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22
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Biggs MA, Brown K, Foster DG. Perceived abortion stigma and psychological well-being over five years after receiving or being denied an abortion. PLoS One 2020; 15:e0226417. [PMID: 31995559 PMCID: PMC6988908 DOI: 10.1371/journal.pone.0226417] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 11/26/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To prospectively assess perceptions of abortion stigma after receiving or being denied an abortion over 5 years, the factors associated with perceived abortion stigma, and the effects of perceived abortion stigma on psychological well-being. METHODS We recruited people seeking abortion from 30 facilities across the US, and interviewed them by phone one week post-abortion seeking, then semiannually for 5 years. We used adjusted mixed effects regression analyses to examine the abortion stigma trajectories of those who obtained an abortion near a facility's gestational age limit (Near-limits) compared to those denied an abortion because they were just over the limit and carried their pregnancies to term (Turnaway-births). RESULTS Of the 956 people recruited, we removed 28 due to ineligibility or missing data, leaving a final sample of 928. In unadjusted analyses, at one-week post-abortion seeking, over half of those seeking abortion perceived that if others knew they had sought an abortion, they would be looked down upon at least "a little bit" by people close to them (60%) or by people in their community (56%). In longitudinal adjusted analyses, people denied an abortion and who carried their pregnancies to term (Turnaway-birth group) reported significantly lower baseline perceived abortion stigma from people close to them (-0.38; 95% CI, -0.59, -0.16) and from people in their community (0.30; 95% CI, -0.52, -0.08), than Near-limits, differences that remained statistically significant for 1.5 years. Overall perceived abortion stigma declined significantly (p < .001) for both study groups. High perceived abortion stigma at baseline was associated with higher odds of experiencing psychological distress years later (adjusted Odds Ratio, 3.98; 95% CI, 1.39, 11.37). CONCLUSIONS Most people considering abortion perceive some abortion stigma, which is associated with psychological distress years later.
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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, California, United States of America
| | - Katherine Brown
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California-San Francisco, San Francisco, California, United States of America
| | - Diana Greene Foster
- 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, California, United States of America
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23
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Ralph LJ, Mauldon J, Biggs MA, Foster DG. A Prospective Cohort Study of the Effect of Receiving versus Being Denied an Abortion on Educational Attainment. Womens Health Issues 2019; 29:455-464. [DOI: 10.1016/j.whi.2019.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 09/28/2019] [Accepted: 09/30/2019] [Indexed: 11/25/2022]
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Akdag Topal C, Terzioglu F. Assessment of depression, anxiety, and social support in the context of therapeutic abortion. Perspect Psychiatr Care 2019; 55:618-623. [PMID: 31004351 DOI: 10.1111/ppc.12380] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 03/25/2019] [Accepted: 03/30/2019] [Indexed: 12/16/2022] Open
Abstract
PURPOSE The purpose of this study is to determine the levels of anxiety, depression, social support, and nursing care needed by women undergoing therapeutic abortion. DESIGNS AND METHODS Sixty women were administered a sociodemographic form, the Hospital Anxiety Depression Scale and the Multidimensional Perceived Social Support Scale. RESULTS More than half of the women experienced anxiety (61.7%). Anxiety scores were high (10.8 ± 3.7), and most of the women had depression (85.0%). Social support from family and friends of the women decreased the women's anxiety and depression levels significantly; social support from their partners also decreased the women's anxiety levels (P < 0.05). PRACTICE IMPLICATIONS Support from family and friends after therapeutic abortion is a fundamental affective variable on anxiety scores.
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Affiliation(s)
- Cansu Akdag Topal
- Department of Obstetrics and Gynecologic Nursing, Faculty of Nursing, Hacettepe University, Sihhiye, Ankara, Turkey
| | - Fusun Terzioglu
- Department of Nursing, Faculty of Health Sciences, Atilim University, Golbasi, Ankara, Turkey
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25
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Heath J, Mitchell N, Fletcher J. A comparison of termination of pregnancy procedures: Patient choice, emotional impact and satisfaction with care. SEXUAL & REPRODUCTIVE HEALTHCARE 2019; 19:42-49. [DOI: 10.1016/j.srhc.2018.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 09/12/2018] [Accepted: 12/02/2018] [Indexed: 01/17/2023]
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26
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Woodruff K, Biggs MA, Gould H, Foster DG. Attitudes Toward Abortion After Receiving vs. Being Denied an Abortion in the USA. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2018; 15:452-463. [PMID: 30956717 PMCID: PMC6449855 DOI: 10.1007/s13178-018-0325-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
U.S. public attitudes toward abortion have been studied extensively, but little is known about these attitudes among women who seek abortion. This mixed-methods study explores women's attitudes about abortion after receiving or being denied an abortion. Data are from the Turnaway Study, a prospective, longitudinal study of women seeking abortions at 30 U.S. facilities. Participants presented just before a facility's gestational limit and received abortions, or just beyond the limit and were denied abortions. Using mixed effects logistic regression, we assessed 812 participants' attitudes about abortion over four years. At five years after abortion-seeking, we conducted in-depth interviews with 31 participants; this analysis includes the comments of 19 participants who discussed their abortion attitudes in those interviews. We find that six months after abortion-seeking, nearly all women supported abortion legality in all (80%) or some (18%) situations, yet 20% also believed abortion is morally wrong. Women denied an abortion were significantly less likely to support the legal right to abortion at six months (62%) and 4.5 years (77%) after abortion-seeking than women who had received a near-limit abortion (78% and 88%, respectively). In open-ended interviews, women expressed nuanced views, including reporting increased empathy for others facing an unwanted pregnancy. Women's own reproductive experiences impact their views on abortion. Distinguishing between morality and legality of abortion is critical in understanding abortion attitudes.
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Affiliation(s)
- Katie Woodruff
- School of Public Health, University of California,
Berkeley, Berkeley, California., 50 University Ave Hall #7360, Berkeley, CA 94720,
Phone: 510-551-9700
| | - M. Antonia Biggs
- Advancing New Standards in Reproductive Health (ANSIRH),
University of California, San Francisco, San Francisco, California., 1330 Broadway,
Suite 1100, Oakland, CA 94612, Phone: 510-986-8990
| | - Heather Gould
- Advancing New Standards in Reproductive Health (ANSIRH),
University of California, San Francisco, San Francisco, California., 1330 Broadway,
Suite 1100, Oakland, CA 94612, Phone: 510-986-8990
| | - Diana Greene Foster
- Advancing New Standards in Reproductive Health (ANSIRH),
University of California, San Francisco, San Francisco, California., 1330 Broadway,
Suite 1100, Oakland, CA 94612, Phone: 510-986-8990
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27
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Abstract
Patients commonly present with unintended pregnancy in the primary care setting, and 1 in 4 women has an abortion in her lifetime. Early abortion services can be safely provided in the primary care setting. Abortion options provided in primary care settings include both medication abortion and early uterine aspiration abortion. Medication abortion, provided up to 10 weeks' gestational age, includes mifepristone (a progestin antagonist) and misoprostol (a prostaglandin). Uterine aspiration can be provided via manual or electronic vacuum in the first trimester.
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Affiliation(s)
- Jennifer R Amico
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, 125 Paterson Street, MEB 262, New Brunswick, NJ 08901, USA.
| | - Terri L Cheng
- Department of Family Medicine and Public Health, University of California San Diego, 200 West Arbor Drive #8201A, San Diego, CA 92103, USA
| | - Emily M Godfrey
- Family Medicine, University of Washington, 4311 11th Avenue Northeast, Suite 210, Box 354982, Seattle, WA 98105, USA; Obstetrics and Gynecology, University of Washington, 4311 11th Avenue Northeast, Suite 210, Box 354982, Seattle, WA 98105, USA
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28
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Hall JA, Barrett G, Copas A, Phiri T, Malata A, Stephenson J. Reassessing pregnancy intention and its relation to maternal, perinatal and neonatal outcomes in a low-income setting: A cohort study. PLoS One 2018; 13:e0205487. [PMID: 30335769 PMCID: PMC6193645 DOI: 10.1371/journal.pone.0205487] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 09/26/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND It is unclear whether unintended pregnancies are associated with adverse outcomes. Data are predominantly from high-income countries and have methodological limitations, calling the findings into question. This research was designed to overcome these limitations and assess the relationships between pregnancy intention and miscarriage, stillbirth, low birthweight, neonatal death and postnatal depression in a low-income country. METHODS The pregnancy intention of 4,244 pregnant women in Mchinji District, Malawi, was measured using the validated Chichewa version of the London Measure of Unplanned Pregnancy (LMUP). Women were re-interviewed postnatally to assess pregnancy outcome. Postnatal depression was assessed using the WHO's Self-Reporting Questionnaire. Multivariable regressions were conducted, with the choice of confounders informed by a pre-existing conceptual epidemiological hierarchy. RESULTS Planned pregnancies are associated with a reduced risk of any (adjusted RR 0.90 [95%CI 0.86, 0.95]) or high symptoms of depression (adjusted RR 0.76 [95%CI 0.63, 0.91]) compared to unplanned pregnancies in rural Malawi. There was no relationship between pregnancy intention and the composite measure of miscarriage, stillbirth, low birthweight and neonatal death. There was some evidence that greater pregnancy intention was associated with reduced adjusted risk of stillbirth (0·93 [95%CI 0·87, 1·00]). CONCLUSION Our study is the first to use a psychometrically valid measure of pregnancy intention, and to do so antenatally. As pregnancy intention increases, the risk of postnatal depression and, possibly, stillbirth decreases. This suggests a new, clinical use for the LMUP; identifying women antenatally who are at risk of these adverse pregnancy outcomes.
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Affiliation(s)
- Jennifer Anne Hall
- Research Department of Reproductive Health, UCL Institute for Women’s Health, London, United Kingdom
- * E-mail:
| | - Geraldine Barrett
- Research Department of Reproductive Health, UCL Institute for Women’s Health, London, United Kingdom
| | - Andrew Copas
- Department of Infection & Population Health, UCL Institute of Epidemiology and Health Care, London, United Kingdom
| | | | - Address Malata
- Malawi University of Science and Technology, Zomba, Malawi
| | - Judith Stephenson
- Research Department of Reproductive Health, UCL Institute for Women’s Health, London, United Kingdom
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29
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Abstract
Despite the growing body of research on the emotion of disgust –
including its relationship to political ideology, moral judgment,
matters of sex and sexuality, and death – the global reproductive
rights movement has paid relatively little attention to the role
disgust plays in the debate over abortion. By focusing on the right of
a woman to make her own decision about an unwanted pregnancy, the
pro-choice community has allowed anti-choice groups to define and
frame the abortion procedure, abortion providers, and women who have
abortions in terms associated with disgust. This commentary encourages
further examination of what triggers disgust, its measurement, and
ways of mitigating it, which could be useful for reducing abortion
stigma, in future legal cases and in abortion research, advocacy, and
communications.
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30
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McNamara B, Russo J, Chaiken S, Jacobson J, Kerns J. A qualitative study of digoxin injection before dilation and evacuation. Contraception 2018; 97:515-519. [PMID: 29477630 DOI: 10.1016/j.contraception.2018.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 02/09/2018] [Accepted: 02/13/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE We sought to qualitatively understand patients' experiences with digoxin as a step before dilation and evacuation (D&E). STUDY DESIGN We recruited English-speaking women from one abortion health center where digoxin is routinely used before D&E. We interviewed participants one to three weeks after the D&E about physical and emotional experiences with digoxin and understanding of its purpose. Using grounded theory, we analyzed transcripts iteratively, identifying themes from interviews; we stopped recruitment when we reached thematic saturation. RESULTS We conducted 20 interviews and participants described mixed experiences. Three overarching themes from the qualitative interviews were: (1) physical and emotional discomfort; (2) varied understanding of digoxin's purpose and effects; and (3) reassurance. Most participants described significantly negative experiences with digoxin; however, many participants also described positive aspects of the injection intermingled with those negative experiences. CONCLUSIONS Participants' experiences with digoxin before D&E were both polarized and nuanced. While participants were largely clear about digoxin's action, they were much less clear about the reason for its use. IMPLICATIONS Both the clinical purpose for and patients' experiences with digoxin before D&E are complicated. Providers who continue to use digoxin should consider patient preferences in how they offer digoxin, and consider tools to ensure patient understanding.
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Affiliation(s)
- Blair McNamara
- Yale University School of Medicine, New Haven, CT 06520, USA.
| | - Jennefer Russo
- Planned Parenthood of Orange and San Bernardino Counties, Orange, CA 92866, USA
| | | | - Janet Jacobson
- Planned Parenthood of Orange and San Bernardino Counties, Orange, CA 92866, USA
| | - Jennifer Kerns
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, CA 94110, USA
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31
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Johnson-Mallard V, Kostas-Polston EA, Woods NF, Simmonds KE, Alexander IM, Taylor D. Unintended pregnancy: a framework for prevention and options for midlife women in the US. Womens Midlife Health 2017; 3:8. [PMID: 30766709 PMCID: PMC6299952 DOI: 10.1186/s40695-017-0027-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 09/05/2017] [Indexed: 12/15/2022] Open
Abstract
Recently unintended pregnancies have been described as "a new kind of mid-life crisis." Given the high prevalence of unwanted or mistimed pregnancy in the US, we examined the sexual and reproductive health patterns of sexually active midlife women. An examination of the prevalence of unintended pregnancy among midlife women revealed a gap in data indicating unmet sexual and reproductive health needs of midlife women. The application of a framework for primary, secondary and tertiary prevention for unintended pregnancy may assist with guiding care for women and identifying implications for reproductive health policy and potential political interference as they relate to sexual and reproductive health in midlife women.
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Affiliation(s)
- Versie Johnson-Mallard
- Department of Family, Community, and Health System Science, Robert Wood Johnson Nurse Faculty Scholar Alum, University of Florida, College of Nursing, Gainesville, FL USA
| | - Elizabeth A. Kostas-Polston
- Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD USA
| | - Nancy Fugate Woods
- Biobehavioral Nursing and Health Informatics, Interim Associate Dean for Diversity, Equity, and Inclusion, University of Washington School of Nursing, Seattle, WA USA
| | | | | | - Diana Taylor
- UCSF School of Nursing, Research Faculty, Advancing New Standards in Reproductive Health Program (ANSIRH), UCSF Bixby Center for Global Reproductive Health, University of California, San Francisco, CA USA
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Abstract
PURPOSE OF REVIEW The early medical literature on mental health outcomes following abortion is fraught with methodological flaws that can improperly influence clinical practice. Our goal is to review the current medical literature on depression and other mental health outcomes for women obtaining abortions. RECENT FINDINGS The Turnaway Study prospectively enrolled 956 women seeking abortion in the USA and followed their mental health outcomes for 5 years. The control group was comprised of women denied abortions based on gestational age limits, thereby circumventing the major methodological flaw that had plagued earlier studies on the topic. Rates of depression are not significantly different between women obtaining abortion and those denied abortion. Rates of anxiety are initially higher in women denied abortion care. Counseling on decision-making for women with unintended pregnancies should reflect these findings.
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LaRoche KJ, Foster AM. “I kind of feel like sometimes I am shoving it under the carpet”: Documenting women’s experiences with post-abortion support in Ontario. Facets (Ott) 2017. [DOI: 10.1139/facets-2017-0059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Abortion has been available without criminal restriction in Canada since 1988, and approximately 33 000 terminations take place in Ontario each year. Objectives: This study aimed to explore women’s expressed desire for post-abortion support services, document the priorities expressed by women in seeking post-abortion support, and identify actionable strategies to improve post-abortion support services in Ontario. Methods: Between 2012 and 2014 we conducted in-depth, open-ended interviews with 60 Anglophone women from across Ontario who had recently had an abortion. We aimed to rigorously explore the compounding issues of age and geography on women’s abortion experiences. We analyzed our data for content and themes and reported on the findings related to post-abortion support. Results: One third of our participants expressed a desire for post-abortion support, yet few were able to access a timely, affordable, non-directive service. Women were uncertain about how to find services; most contacted a provider recommended by the clinic or searched online. Women were enthusiastic about a talkline format citing anonymity and convenience as the main advantages. Conclusion: Our results suggest that exploring ways to expand post-abortion support services in Ontario is warranted. A talkline format could provide an anonymous, convenient, non-judgmental, and non-directive way to address this unmet need.
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Affiliation(s)
- Kathryn J. LaRoche
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Angel M. Foster
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Institute of Population Health, University of Ottawa, Ottawa, ON K1N 6N5, Canada
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Marecek J, Macleod C, Hoggart L. Abortion embedded and embodied in social relations: Challenges for feminist psychology. FEMINISM & PSYCHOLOGY 2017. [DOI: 10.1177/0959353517704877] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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35
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Hall JA, Barrett G, Copas A, Stephenson J. London Measure of Unplanned Pregnancy: guidance for its use as an outcome measure. PATIENT-RELATED OUTCOME MEASURES 2017; 8:43-56. [PMID: 28435343 PMCID: PMC5388237 DOI: 10.2147/prom.s122420] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background The London Measure of Unplanned Pregnancy (LMUP) is a psychometrically validated measure of the degree of intention of a current or recent pregnancy. The LMUP is increasingly being used worldwide, and can be used to evaluate family planning or preconception care programs. However, beyond recommending the use of the full LMUP scale, there is no published guidance on how to use the LMUP as an outcome measure. Ordinal logistic regression has been recommended informally, but studies published to date have all used binary logistic regression and dichotomized the scale at different cut points. There is thus a need for evidence-based guidance to provide a standardized methodology for multivariate analysis and to enable comparison of results. This paper makes recommendations for the regression method for analysis of the LMUP as an outcome measure. Materials and methods Data collected from 4,244 pregnant women in Malawi were used to compare five regression methods: linear, logistic with two cut points, and ordinal logistic with either the full or grouped LMUP score. The recommendations were then tested on the original UK LMUP data. Results There were small but no important differences in the findings across the regression models. Logistic regression resulted in the largest loss of information, and assumptions were violated for the linear and ordinal logistic regression. Consequently, robust standard errors were used for linear regression and a partial proportional odds ordinal logistic regression model attempted. The latter could only be fitted for grouped LMUP score. Conclusion We recommend the linear regression model with robust standard errors to make full use of the LMUP score when analyzed as an outcome measure. Ordinal logistic regression could be considered, but a partial proportional odds model with grouped LMUP score may be required. Logistic regression is the least-favored option, due to the loss of information. For logistic regression, the cut point for un/planned pregnancy should be between nine and ten. These recommendations will standardize the analysis of LMUP data and enhance comparability of results across studies.
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Affiliation(s)
- Jennifer A Hall
- Research Department of Reproductive Health, UCL Institute for Women's Health
| | - Geraldine Barrett
- Research Department of Reproductive Health, UCL Institute for Women's Health
| | - Andrew Copas
- Department of Infection & Population Health, UCL Institute of Epidemiology and Health Care, London, UK
| | - Judith Stephenson
- Research Department of Reproductive Health, UCL Institute for Women's Health
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36
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Aiken AR, Trussell J. Anticipated Emotions about Unintended Pregnancy in Relationship Context: Are Latinas Really Happier? JOURNAL OF MARRIAGE AND THE FAMILY 2017; 79:356-371. [PMID: 28316342 PMCID: PMC5353845 DOI: 10.1111/jomf.12338] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 05/02/2016] [Indexed: 05/19/2023]
Abstract
This study examined differences in women's anticipated emotional orientations towards unintended pregnancy by relationship status and race/ethnicity. Data from a prospective survey of 437 women aged 18-44 who intended no more children for at least two years were analyzed along with 27 in-depth interviews among a diverse sub-sample. Cohabiting women and women in a romantic relationship not living together were less likely to profess happiness (OR=0.42, p<.05, OR=0.25, p<.01, respectively), even when partners' intentions/feelings were controlled. The most prominent factor underlying negative feelings was partners' anticipated lack of engagement with the emotional, physical, and financial toll of unintended childbearing. Contrary to conventional wisdom regarding the "Hispanic paradox", foreign-born and US-born Latinas were no more likely to profess happiness than non-Hispanic whites or blacks. Moreover, foreign-born Latinas whose survey responses indicated happiness often revealed highly negative feelings at in-depth interview, citing pressure to conform to sociocultural norms surrounding motherhood and abortion.
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Affiliation(s)
- Abigail R.A. Aiken
- Office of Population Research, Wallace Hall, Princeton University, Princeton, NJ, 08544, USA
| | - James Trussell
- Office of Population Research, Wallace Hall, Princeton University, Princeton, NJ, 08544, USA
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Abstract
Despite an increasing number of restrictions on accessing abortion care in the United States, most Americans remain unaware of challenges to obtaining abortion. Theorists of abortion stigma have posited that entertainment media contribute to ongoing lack of knowledge about abortion care. Analyzing all plotlines that aired on American television between 2005 and 2015 in which abortion is considered (n = 89), we examine how access to abortion is portrayed, whether characters are able to surmount barriers, and what documented real-life challenges to access are missing from onscreen representations. We find that 42% show at least one barrier to accessing abortion care, most frequently illegality, cost of the procedure, and social stigma. Almost no barriers—including illegality—are insurmountable, and most are easily overcome for the characters seeking abortion. Some barriers, however, change how abortion is understood by a character such that she opts to continue the pregnancy. This underrepresentation of the difficulty of obtaining abortion care may contribute to public beliefs that abortion restrictions do not pose real challenges for women’s access to abortion.
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38
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Sisson G, Ralph L, Gould H, Foster DG. Adoption Decision Making among Women Seeking Abortion. Womens Health Issues 2017; 27:136-144. [PMID: 28153742 DOI: 10.1016/j.whi.2016.11.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 10/25/2016] [Accepted: 11/29/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Little is known about how adoption factors into pregnancy decision making, particularly when abortion is unavailable. METHODS We used data from the Turnaway Study, a longitudinal study of 956 women seeking abortion, including 231 women denied abortions owing to gestational limits. Through semiannual quantitative interviews, we assessed the frequency with which women denied abortion consider and choose adoption, and, among adoption participants, decision satisfaction. We compared differences in the demographic profiles of parenting and adoption participants using mixed effects regression models. We conducted in-depth interviews with 31 women who received or were denied wanted abortions, including 2 adoption participants, focused on understanding pregnancy decision making and feelings about their choice. Interviews were coded using inductive and deductive methods. RESULTS Most women who received abortions were aware of but uninterested in adoption. A minority of women denied abortions (n = 231; 14%) were considering adoption at 1 week after denial. Of participants who gave birth (n = 161), most (91%) chose parenting. Parenting participants (n = 146) did not differ from adoption participants (n = 15) on measures of age, race, or poverty status, although adoption participants were somewhat less likely to be employed (20% vs. 43%; p = .1), and somewhat more likely to have completed high school (87% vs. 74%; p = .08). Although satisfaction with their decision was high among adoption participants, in-depth interviews revealed mixed emotions. CONCLUSIONS Among women motivated to avoid parenthood, as evidenced by abortion seeking, adoption is considered or chosen infrequently. Political promotion of adoption as an alternative to abortion is likely not grounded in the reality of women's decision making.
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Affiliation(s)
- Gretchen Sisson
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, San Francisco, California.
| | - Lauren Ralph
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, San Francisco, California
| | - Heather Gould
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, San Francisco, California
| | - Diana Greene Foster
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, San Francisco, California
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Berglas NF, Gould H, Turok DK, Sanders JN, Perrucci AC, Roberts SCM. State-Mandated (Mis)Information and Women's Endorsement of Common Abortion Myths. Womens Health Issues 2017; 27:129-135. [PMID: 28131389 DOI: 10.1016/j.whi.2016.12.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 12/16/2016] [Accepted: 12/20/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE The extent that state-mandated informed consent scripts affect women's knowledge about abortion is unknown. We examine women's endorsement of common abortion myths before and after receiving state-mandated information that included accurate and inaccurate statements about abortion. METHODS In Utah, women presenting for an abortion information visit completed baseline surveys (n = 494) and follow-up interviews 3 weeks later (n = 309). Women answered five items about abortion risks, indicating which of two statements was closer to the truth (as established by prior research) or responding "don't know." We developed a continuous myth endorsement scale (range, 0-1) and, using multivariable regression models, examined predictors of myth endorsement at baseline and change in myth endorsement from baseline to follow-up. RESULTS At baseline, many women reported not knowing about abortion risks (range, 36%-70% across myths). Women who were younger, non-White, and had previously given birth but not had a prior abortion reported higher myth endorsement at baseline. Overall, myth endorsement decreased after the information visit (0.37-0.31; p < .001). However, endorsement of the myth that was included in the state script-describing inaccurate risks of depression and anxiety-increased at follow-up (0.47-0.52; p < .05). CONCLUSIONS Lack of knowledge about the effects of abortion is common. Knowledge of information that was accurately presented or not referenced in state-mandated scripts increased. In contrast, inaccurate information was associated with decreases in women's knowledge about abortion, violating accepted principles of informed consent. State policies that require or result in the provision of inaccurate information should be reconsidered.
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Affiliation(s)
- Nancy F Berglas
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, Oakland, California.
| | - Heather Gould
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, Oakland, California
| | - David K Turok
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
| | - Jessica N Sanders
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
| | - Alissa C Perrucci
- Women's Options Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - Sarah C M Roberts
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, Oakland, California
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40
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“Not Brain-washed, but Heart-washed”: A Qualitative Analysis of Benevolent Sexism in the Anti-Choice Stance. Int J Behav Med 2017; 24:864-870. [DOI: 10.1007/s12529-017-9633-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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41
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Pereira J, Pires R, Canavarro MC. Psychosocial adjustment after induced abortion and its explanatory factors among adolescent and adult women. J Reprod Infant Psychol 2017. [PMID: 29517360 DOI: 10.1080/02646838.2016.1276281] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To compare the depressive symptoms and quality of life (QoL) among adolescents (<20 years) and adult women who have had an abortion and to explore individual, social, relational and decision-making explanatory factors for (mal)adjustment in each group. BACKGROUND International findings are not consistent regarding the presence of negative psychosocial outcomes after abortion or about the explanatory factors for occurrence among adolescents and adult women. METHODS In this cross-sectional study, 177 adolescents (65.1%) and 95 adult women (34.9%) who underwent abortion were recruited. Data on individual, social, relational and decision-making characteristics, depressive symptoms (Edinburgh Postnatal Depression Scale) and QoL (EUROHIS-QOL-8) were collected through self-report questionnaires at 16 healthcare services that provide abortion. RESULTS Although adolescents are not at greater risk of maladjustment than adult women, abortion may be an emotionally significant event for both age groups. Regarding adolescents, feelings of being pressured into abortion and lower satisfaction with the abortion decision were significantly associated with depressive symptoms and lower QoL. Lower support from the mother was also associated with lower QoL. With regard to adult women, lower satisfaction with the abortion decision was significantly associated with depressive symptoms. None of variables was significantly associated with QoL. CONCLUSION Our results suggest that adolescents are not at greater risk of psychosocial maladjustment than are adult women. Factors from different ecological contexts and specific factors depending on age group should be considered in preventive interventions for (mal)adjustment after abortion.
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Affiliation(s)
- Joana Pereira
- a Faculty of Psychology and Educational Sciences , University of Coimbra , Coimbra , Portugal.,b Psychological Intervention Unit of the Maternity Daniel de Matos , Centro Hospitalar e Universitário de Coimbra, EPE , Coimbra , Portugal
| | - Raquel Pires
- a Faculty of Psychology and Educational Sciences , University of Coimbra , Coimbra , Portugal.,c School of Psychology and Life Sciences , Lusófona University of Humanities and Technology , Lisbon , Portugal
| | - Maria Cristina Canavarro
- a Faculty of Psychology and Educational Sciences , University of Coimbra , Coimbra , Portugal.,b Psychological Intervention Unit of the Maternity Daniel de Matos , Centro Hospitalar e Universitário de Coimbra, EPE , Coimbra , Portugal
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42
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van Ditzhuijzen J, Ten Have M, de Graaf R, Lugtig P, van Nijnatten CHCJ, Vollebergh WAM. Incidence and recurrence of common mental disorders after abortion: Results from a prospective cohort study. J Psychiatr Res 2017; 84:200-206. [PMID: 27760409 DOI: 10.1016/j.jpsychires.2016.10.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 09/30/2016] [Accepted: 10/10/2016] [Indexed: 11/19/2022]
Abstract
Research in the field of mental health consequences of abortion is characterized by methodological limitations. We used exact matching on carefully selected confounders in a prospective cohort study of 325 women who had an abortion of an unwanted pregnancy and compared them 1-to-1 to controls who did not have this experience. Outcome measures were incidence and recurrence of common DSM-IV mental disorders (mood, anxiety, substance use disorders, and the aggregate measure 'any mental disorder') as measured with the Composite International Diagnostic Interview (CIDI) version 3.0, in the 2.5-3 years after the abortion. Although non-matched data suggested otherwise, women in the abortion group did not show significantly higher odds for incidence of 'any mental disorder', or mood, anxiety and substance use disorders, compared to matched controls who were similar in background variables but did not have an this experience. Having an abortion did not increase the odds for recurrence of the three disorder categories, but for any mental disorder the higher odds in the abortion group remained significant after matching. It is unlikely that termination of an unwanted pregnancy increases the risk on incidence of common mental disorders in women without a psychiatric history. However, it might increase the risk of recurrence among women with a history of mental disorders.
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Affiliation(s)
- Jenneke van Ditzhuijzen
- Department of Interdisciplinary Social Sciences, Utrecht University, Utrecht, The Netherlands.
| | - Margreet Ten Have
- Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Utrecht, The Netherlands
| | - Ron de Graaf
- Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Utrecht, The Netherlands
| | - Peter Lugtig
- Department of Methodology and Statistics, Utrecht University, Utrecht, The Netherlands
| | | | - Wilma A M Vollebergh
- Department of Interdisciplinary Social Sciences, Utrecht University, Utrecht, The Netherlands
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43
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Andaya E, Mishtal J. The Erosion of Rights to Abortion Care in the United States: A Call for a Renewed Anthropological Engagement with the Politics of Abortion. Med Anthropol Q 2016; 31:40-59. [DOI: 10.1111/maq.12298] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 01/28/2016] [Accepted: 04/11/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Elise Andaya
- Department of Anthropology; University at Albany (SUNY)
| | - Joanna Mishtal
- Department of Anthropology; University of Central Florida
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44
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Ralph LJ, Foster DG, Kimport K, Turok D, Roberts SCM. Measuring decisional certainty among women seeking abortion. Contraception 2016; 95:269-278. [PMID: 27745910 DOI: 10.1016/j.contraception.2016.09.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 08/31/2016] [Accepted: 09/04/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Evaluating decisional certainty is an important component of medical care, including preabortion care. However, minimal research has examined how to measure certainty with reliability and validity among women seeking abortion. We examine whether the Decisional Conflict Scale (DCS), a measure widely used in other health specialties and considered the gold standard for measuring this construct, and the Taft-Baker Scale (TBS), a measure developed by abortion counselors, are valid and reliable for use with women seeking abortion and predict the decision to continue the pregnancy. METHODS Eligible women at four family planning facilities in Utah completed baseline demographic surveys and scales before their abortion information visit and follow-up interviews 3 weeks later. For each scale, we calculated mean scores and explored factors associated with high uncertainty. We evaluated internal reliability using Cronbach's alpha and assessed predictive validity by examining whether higher scale scores, indicative of decisional uncertainty or conflict, were associated with still being pregnant at follow-up. RESULTS Five hundred women completed baseline surveys; two-thirds (63%) completed follow-up, at which time 11% were still pregnant. Mean scores on the DCS (15.5/100) and TBS (12.4/100) indicated low uncertainty, with acceptable reliability (α=.93 and .72, respectively). Higher scores on each scale were significantly and positively associated with still being pregnant at follow-up in both unadjusted and adjusted analyses. CONCLUSION The DCS and TBS demonstrate acceptable reliability and validity among women seeking abortion care. Comparing scores on the DCS in this population to other studies of decision making suggests that the level of uncertainty in abortion decision making is comparable to or lower than other health decisions. IMPLICATIONS The high levels of decisional certainty found in this study challenge the narrative that abortion decision making is exceptional compared to other healthcare decisions and requires additional protection such as laws mandating waiting periods, counseling and ultrasound viewing.
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Affiliation(s)
- Lauren J Ralph
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612, USA.
| | - Diana Greene Foster
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612, USA.
| | - Katrina Kimport
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612, USA.
| | - David Turok
- University of Utah, Department of Obstetrics and Gynecology, 50 N Medical Dr, Salt Lake City, UT 84132, USA.
| | - Sarah C M Roberts
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612, USA.
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45
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Begun S, Bird M, Ramseyer Winter V, Massey Combs K, McKay K. Correlates of Social Work Students' Abortion Knowledge and Attitudes: Implications for Education and Research. SOCIAL WORK IN PUBLIC HEALTH 2016; 31:276-87. [PMID: 27092856 DOI: 10.1080/19371918.2015.1137510] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Researchers have established that individuals' abortion knowledge is positively associated with their support of abortion rights. However, social workers' personal beliefs regarding abortion are under-researched, even though social workers are often employed in health promotion and education roles in which the topic of abortion is encountered. The current study examines the results of a nationwide survey of social work students (N = 504) and explores the relationship between social work students' abortion knowledge and abortion attitudes. Less abortion knowledge was significantly associated with antichoice attitude endorsement. Implications for social work research, training, and education are subsequently discussed.
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Affiliation(s)
- Stephanie Begun
- a Graduate School of Social Work, University of Denver Denver , Colorado , USA
| | - Melissa Bird
- b School of Social Work, University of Southern California Los Angeles , California , USA
| | | | - Katie Massey Combs
- a Graduate School of Social Work, University of Denver Denver , Colorado , USA
| | - Kimberly McKay
- d School of Social Work, Temple University Philadelphia , Pennsylvania , USA
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46
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Roberts SCM, Subbaraman MS, Delucchi KL, Wilsnack SC, Foster DG. Moderators and mediators of the relationship between receiving versus being denied a pregnancy termination and subsequent binge drinking. Drug Alcohol Depend 2016; 159:117-24. [PMID: 26747416 PMCID: PMC4724544 DOI: 10.1016/j.drugalcdep.2015.11.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 11/21/2015] [Accepted: 11/28/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Women who terminate pregnancies drink more subsequent to the pregnancy than women who give birth, including women who give birth after seeking to terminate a pregnancy. METHODS Data are from the Turnaway Study, a prospective, longitudinal study of 956 women who sought to terminate pregnancies at 30 U.S. facilities. This paper focuses on the 452 women who received terminations just below facility gestational limits and 231 who were denied terminations because they presented just beyond facility gestational limits. This study examined whether baseline characteristics moderate the relationship between termination and subsequent binge drinking and whether stress, feelings about the pregnancy, and number of social roles mediate the relationship. RESULTS Only having had a previous live birth modified the termination-binge drinking relationship. Among women with previous live births, binge drinking was reduced among women carrying to term compared to terminating the pregnancy. Among women who had not had a previous live birth, however, the reduction in binge drinking among those denied termination was not sustained over time, and binge drinking of those who had and had not had terminations converged by 2.5 years. Neither stress, negative emotions, nor social roles mediated effects on binge drinking. Positive emotions at one week mediated effects on binge drinking at six months, although positive emotions at two years did not mediate effects on binge drinking at 2.5 years. CONCLUSIONS Higher levels of binge drinking among those who terminate pregnancies do not appear due to stress or to negative emotions. Only parous women - and not nulliparous women - denied terminations experienced sustained reductions in binge drinking over time.
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Affiliation(s)
- S C M Roberts
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94706, USA.
| | - M S Subbaraman
- Alcohol Research Group, Public Health Institute, 6475 Christie Avenue, Suite 400, Emeryville, CA 94608, USA.
| | - K L Delucchi
- Department of Psychiatry, University of California, San Francisco, Box 0984 TRC, 401 Parnassus Avenue, Langley Porter Room 379, San Francisco, CA 94143, USA.
| | - S C Wilsnack
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine & Health Sciences, 501 North Columbia Road Stop 9037, Grand Forks, ND 58202-9037, USA.
| | - D G Foster
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94706, USA.
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47
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Biggs MA, Rowland B, McCulloch CE, Foster DG. Does abortion increase women's risk for post-traumatic stress? Findings from a prospective longitudinal cohort study. BMJ Open 2016; 6:e009698. [PMID: 26832431 PMCID: PMC4746441 DOI: 10.1136/bmjopen-2015-009698] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To prospectively assess women's risk for post-traumatic stress disorder (PTSD) and of experiencing post-traumatic stress symptoms (PTSS) over 4 ears after seeking an abortion, and to assess whether symptoms are attributed to the pregnancy, abortion or birth, or other events in women's lives. DESIGN Prospective longitudinal cohort study which followed women from approximately 1 week after receiving or being denied an abortion (baseline), then every 6 months for 4 years (9 interview waves). SETTING 30 abortion facilities located throughout the USA. PARTICIPANTS Among 956 women presenting for abortion care, some of whom received an abortion and some of whom were denied due to advanced gestational age; 863 women are included in the longitudinal analyses. MAIN OUTCOME MEASURES PTSS and PTSD risk were measured using the Primary Care PTSD Screen (PC-PTSD). Index pregnancy-related PTSS was measured by coding the event(s) described by women as the cause of their symptoms. ANALYSES We used unadjusted and adjusted logistic mixed-effects regression analyses to assess whether PTSS, PTSD risk and pregnancy-related PTSS trajectories of women obtaining abortions differed from those who were denied one. RESULTS At baseline, 39% of participants reported any PTSS and 16% reported three or more symptoms. Among women with symptoms 1-week post-abortion seeking (n=338), 30% said their symptoms were due to experiences of sexual, physical or emotional abuse or violence; 20% attributed their symptoms to non-violent relationship issues; and 19% said they were due to the index pregnancy. Baseline levels of PTSS, PTSD risk and pregnancy-related PTSS outcomes did not differ significantly between women who received and women who were denied an abortion. PTSS, PTSD risk and pregnancy-related PTSS declined over time for all study groups. CONCLUSIONS Women who received an abortion were at no higher risk of PTSD than women denied an abortion.
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Affiliation(s)
- M Antonia Biggs
- Advancing New Standards in Reproductive Health, A Program of the University of California, San Francisco, Oakland, California, USA
| | - Brenly Rowland
- Advancing New Standards in Reproductive Health, A Program of the University of California, San Francisco, Oakland, California, USA
| | - Charles E McCulloch
- Department of Epidemiology & Biostatistics, University of California, San Francisco, California, USA
| | - Diana G Foster
- Advancing New Standards in Reproductive Health, A Program of the University of California, San Francisco, Oakland, California, USA
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Side Effects, Physical Health Consequences, and Mortality Associated with Abortion and Birth after an Unwanted Pregnancy. Womens Health Issues 2015; 26:55-9. [PMID: 26576470 DOI: 10.1016/j.whi.2015.10.001] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 09/30/2015] [Accepted: 10/06/2015] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The safety of abortion in the United States has been documented extensively. In the context of unwanted pregnancy, however, there are few data comparing the health consequences of having an abortion versus carrying an unwanted pregnancy to term. METHODS We examine and compare the self-reported physical health consequences after birth and abortion among participants of the Turnaway Study, which recruited women seeking abortions at 30 clinics across the United States. We also investigate and report maternal mortality among all women enrolled in the study. RESULTS In our study sample, women who gave birth reported potentially life-threatening complications, such as eclampsia and postpartum hemorrhage, whereas those having abortions did not. Women who gave birth reported the need to limit physical activity for a period of time three times longer than that reported by women who received abortions. Among all women enrolled in the Turnaway Study, one maternal death was identified-one woman who had been denied an abortion died from a condition that confers a higher risk of death among pregnant women. CONCLUSION These results reinforce the existing data on the safety of induced abortion when compared with childbirth, and highlight the risk of serious morbidity and mortality associated with childbirth after unwanted pregnancy.
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Biggs MA, Neuhaus JM, Foster DG. Mental Health Diagnoses 3 Years After Receiving or Being Denied an Abortion in the United States. Am J Public Health 2015; 105:2557-63. [PMID: 26469674 DOI: 10.2105/ajph.2015.302803] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We set out to assess the occurrence of new depression and anxiety diagnoses in women 3 years after they sought an abortion. METHODS We conducted semiannual telephone interviews of 956 women who sought abortions from 30 US facilities. Adjusted multivariable discrete-time logistic survival models examined whether the study group (women who obtained abortions just under a facility's gestational age limit, who were denied abortions and carried to term, who were denied abortions and did not carry to term, and who received first-trimester abortions) predicted depression or anxiety onset during seven 6-month time intervals. RESULTS The 3-year cumulative probability of professionally diagnosed depression was 9% to 14%; for anxiety it was 10% to 15%, with no study group differences. Women in the first-trimester group and women denied abortions who did not give birth had greater odds of new self-diagnosed anxiety than did women who obtained abortions just under facility gestational limits. CONCLUSIONS Among women seeking abortions near facility gestational limits, those who obtained abortions were at no greater mental health risk than were women who carried an unwanted pregnancy to term.
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Affiliation(s)
- M Antonia Biggs
- M. Antonia Biggs and Diana G. Foster are with Advancing New Standards in Reproductive Health, University of California, San Francisco, Oakland. John M. Neuhaus is with the Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - John M Neuhaus
- M. Antonia Biggs and Diana G. Foster are with Advancing New Standards in Reproductive Health, University of California, San Francisco, Oakland. John M. Neuhaus is with the Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Diana G Foster
- M. Antonia Biggs and Diana G. Foster are with Advancing New Standards in Reproductive Health, University of California, San Francisco, Oakland. John M. Neuhaus is with the Department of Epidemiology and Biostatistics, University of California, San Francisco
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The impact of psychiatric history on women's pre- and postabortion experiences. Contraception 2015; 92:246-53. [DOI: 10.1016/j.contraception.2015.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 05/03/2015] [Accepted: 05/09/2015] [Indexed: 11/19/2022]
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