How Ohio's proposed abortion bans would impact travel distance to access abortion care

Trends in interstate abortion travel to Oregon following the Dobbs court decision

OBJECTIVES

This study describes how interstate travel for abortion to the state of Oregon changed following the Dobbs decision.

STUDY DESIGN

We conducted a retrospective cohort study using vital statistics data from the Oregon Health Authority of all medical and surgical abortions between 2015 and 2023.

RESULTS

Following the Dobbs decision, 14.3% of abortions in Oregon were out-of-state residents, compared to 9.6% pre-Dobbs. Out-of-state individuals had significantly higher odds of having abortions in the second or third trimester and having a procedural abortion compared to their in-state counterparts.

CONCLUSIONS

Following the Dobbs decision, interstate travel to Oregon increased significantly and represents a distinct population.

Impact of the Dobbs decision on abortion services from a large tertiary center in Oregon

OBJECTIVES

Evaluate the impact of the Dobbs vs Jackson decision on abortion care at an academic center in Oregon, a state with no legal restrictions on abortion.

STUDY DESIGN

Electronic health records from patients who received an abortion at Oregon's largest tertiary hospital were utilized to compare the years before and after Dobbs.

RESULTS

Monthly average abortions increased from 57.8 pre-Dobbs to 77.1 post-Dobbs (p = 0.001). This trend was associated with an increased proportion of out-of-state patients (14.3% vs 9.5%, p = 0.004) presenting with gestational duration ≥26 weeks (23.6% vs 3.7% in-state, p < 0.001).

CONCLUSIONS

The Dobbs decision resulted in increased utilization of hospital-based abortion care in a protective state.

IMPLICATIONS

This study reflects the critical role of protective states such as Oregon in preserving access to abortion services and the need for continued support to alleviate the impact of nationwide barriers to reproductive healthcare.

The impact of state Medicaid coverage of abortion on people accessing care in three states

CONTEXT

Medicaid is a major funder of reproductive health services, including family planning and pregnancy-related care, especially for people with limited income and people of color. Federal Medicaid funds cannot be used for abortion however 16 states allow state Medicaid funds to pay for abortion. In recent years, Illinois and Maine implemented, and West Virginia discontinued, state Medicaid coverage of abortion.

METHODOLOGY

With retrospective procedure- and patient-level data obtained from clinics in these three states, we used an interrupted time series design, multivariable regression models, and descriptive statistics to assess changes in procedure volume and patients' share of total procedure price (patient price).

RESULTS

In Maine and Illinois, implementing state Medicaid coverage of abortion contributed to an immediate overall increase in abortion access (as seen by a rise in monthly procedure volume at the time of the policy's implementation), a decrease in patient price (by 36% in Maine and 44% in Illinois) after policy implementation as compared to pre-implementation, and overall improved access among people of color. Conversely, when West Virginia discontinued coverage, access to care decreased, patient price increased by 130%, and the share of abortion procedures among people of color decreased.

CONCLUSIONS

In the fragmented abortion access landscape of the post-Roe era, our study provides new evidence that financial assistance offered through state Medicaid policies that cover abortion may be most helpful to those facing traditional structural inequities to access, while discontinuation of Medicaid coverage of abortion further burdens those already economically marginalized.

Seeking financial and practical support in an abortion-hostile state: Analysis of abortion fund data in Kentucky, 2014-2021: Analysis of abortion fund data in Kentucky

OBJECTIVES

Philanthropic abortion funds are integral to accessing care in the United States, providing both financial and practical assistance. Yet relatively little is known about those who seek these essential services. In this study, we analyzed data from a Kentucky abortion fund to assess characteristics of abortion fund callers.

METHODS

We analyzed 2014-2021 administrative data from the Kentucky Health Justice Network's (KHJN) Abortion Support Fund and compared them to abortion data from the Kentucky Department for Public Health (KDPH). We analyzed age, race, and pregnancy gestation at calling (KHJN) and abortion (KDPH), and calculated Z-scores and p-values to compare proportions in each category between the two data sources.

RESULTS

The fund supported 6162 people from 2014 to 2021, when 28,741 people had abortions in Kentucky. Compared with KDPH data, KHJN had a higher percentage of callers who were under age 30, a higher percentage of callers who were Black or another race, and a higher percentage of callers at 14 weeks' gestation or higher.

CONCLUSIONS

Compared with state data, KHJN supported a higher percentage of young people, people of color, and people at later gestations. These findings support evidence that structurally vulnerable groups are more likely to face barriers to care and that abortion funds provide essential support necessary for reproductive equity.

The patient/physician relationship in a post-Roe world: a neonatologist viewpoint

The Supreme Court ruling in Dobbs v. Jackson Women's Health Organization has far-reaching implications that go beyond the practice of obstetrics and gynecology. The ruling and subsequent laws and bills impact many specialties and have implications for healthcare as a whole. The rapidly changing medicolegal landscape has significant bearings on and implications for the fields of neonatology and pediatrics. These rulings have an impact on the patient-physician relationship and a shared decision-making approach to care. Furthermore, there are significant sequelae of forced birth and resuscitation. This review provides a clinically relevant update of the current medicolegal landscape and applications to the practice of neonatology.

Examining ethno-racial attitudes of the public in Twitter discourses related to the United States Supreme Court Dobbs vs. Jackson Women's Health Organization ruling: A machine learning approach

Background

The decision of the US Supreme Court to repeal Roe vs. Wade sparked significant media attention. Although primarily related to abortion, opinions are divided about how this decision would impact disparities, especially for Black, Indigenous, and people of color. We used advanced natural language processing (NLP) techniques to examine ethno-racial contents in Twitter discourses related to the overturn of Roe vs. Wade.

Methods

We screened approximately 3 million tweets posted to Roe vs. Wade discussions and identified unique tweets in English-language that had mentions related to race, ethnicity, and racism posted between June 24 and July 10, 2022. We performed lexicon-based sentiment analysis to identify sentiment polarity and the emotions expressed in the Twitter discourse and conducted structural topic modeling to identify and examine latent themes.

Results

Of the tweets retrieved, 0.7% (n = 23,044) had mentions related to race, ethnicity, and racism. The overall sentiment polarity was negative (mean = -0.41, SD = 1.48). Approximately 60.0% (n = 12,092) expressed negative sentiments, while 39.0% (n = 81,45) expressed positive sentiments, and 3.0% (n = 619) expressed neutral sentiments. There were 20 latent themes which emerged from the topic model. The predominant topics in the discourses were related to "racial resentment" (topic 2, 11.3%), "human rights" (topic 2, 7.9%), and "socioeconomic disadvantage" (topic 16, 7.4%).

Conclusions

Our study demonstrates wide ranging ethno-racial concerns following the reversal of Roe and supports the need for active surveillance of racial and ethnic disparities in abortion access in the post-Roe era.

Seeking abortion care in Ohio and Texas during the COVID-19 pandemic

OBJECTIVES

Political and public health responses to the COVID-19 pandemic changed provision of abortion care and exacerbated existing barriers. We aimed to explore experiences of individuals seeking abortion care in 2 abortion-restrictive states in the United States where state policies and practice changes disrupted abortion provision during the pandemic.

STUDY DESIGN

We conducted 22 semistructured interviews in Texas (n = 10) and Ohio (n = 12) to assess how state executive orders limiting abortion, along with other public health guidance and pandemic-related service delivery changes, affected individuals seeking abortion care. We included individuals 18 years and older who contacted a facility for abortion care between March and November 2020. We coded and analyzed interview transcripts using both inductive and deductive approaches.

RESULTS

Participants reported obstacles to obtaining their preferred timing and method of abortion. These obstacles placed greater demands on those seeking abortion and resulted in delays in obtaining care for as long as 11 weeks, as well as some being unable to obtain an abortion at all.

CONCLUSIONS

Political and public health responses to the COVID-19 pandemic - exacerbated pre-pandemic barriers and existing restrictions and constrained options for people seeking abortion in Ohio and Texas. Delays were consequential for all participants, regardless of their ultimate ability to obtain an abortion.

IMPLICATIONS

During the COVID-19 pandemic, state executive orders and clinic practices exacerbated already constrained access to care. Findings highlight the importance of protecting timely care and the full range of abortion methods. Findings also preview barriers individuals seeking abortion may encounter in states that restrict or ban abortion.

Assessing psychosocial costs: Ohio patients' experiences seeking abortion care

OBJECTIVES

Existing research has not thoroughly characterized the psychosocial costs associated with seeking abortion care in restrictive states. Our study seeks to fill this gap by analyzing the accounts of Ohio abortion patients from 2018 to 2019.

STUDY DESIGN

Using inductive and deductive approaches, we analyzed semi-structured in-depth qualitative interviews with 41 Ohio residents who obtained abortion care from one of three clinics in Ohio or Pennsylvania.

RESULTS

Ohioans seeking abortion care often experienced fear of judgment, interpersonal strain, and stress as a result of efforts to overcome pre-Dobbs financial, geographic, and timing challenges. Those who needed financial assistance or traveled more than an hour generally reported greater exposure to psychosocial costs.

CONCLUSIONS

Participants in this study incurred a complex set of psychosocial costs. Psychosocial costs often resulted from, or were exacerbated by, the financial, geographic, and time-sensitive burdens that patients experienced seeking care.

IMPLICATIONS

The psychosocial costs incurred by patients seeking abortion care may be exacerbated in restrictive contexts, especially those who do not have access to insurance coverage for care. Psychosocial costs associated with care seeking are likely to increase as states implement more severe restrictions post-Dobbs. To fully understand abortion costs, researchers must examine costs comprehensively, including both financial and psychosocial costs.

The timing of intravenous oxytocin administration is crucial to minimize perioperative blood loss during first-trimester suction curettage for missed abortion

BACKGROUND

Oxytocin is commonly used to reduce blood loss during suction curettage for missed abortion. However, the potential of oxytocin to mitigate blood loss in early pregnancy remains controversial. Based on the hypothesis that the "timing" of oxytocin administration may be a critical factor, we investigated whether the timing of intravenous (IV) administration is associated with reduced perioperative blood loss during first-trimester suction curettage for missed abortion.

METHODS

The medical charts of 146 patients with ultrasound-confirmed first-trimester missed abortion who underwent suction curettage with IV oxytocin administration were retrospectively reviewed.

RESULTS

Among the patients, 67 received 10 IU of IV oxytocin before suction curettage (early-oxytocin administration group), while 79 patients received 10 IU of IV oxytocin after suction curettage (late-oxytocin administration group). The demographic features between the two groups did not significantly differ. However, there was a lower proportion of nulliparous patients in the early-oxytocin administration group than in the late-oxytocin administration group (38.8% vs 60.8%, p = 0.006). The perioperative blood loss amount was significantly lower in the early-oxytocin administration group than in the late-oxytocin administration group (60 [range: 50-100] vs 100 [range: 30-250] mL, p = 0.001). Moreover, the multivariate logistic regression analysis showed that the early-oxytocin administration group had a lower risk for a perioperative blood loss amount of ≥100 mL than the late-oxytocin administration group (0.23 [range: 0.10-0.55], p = 0.001); a gestational age of 9-12 weeks ( p = 0.009) was found to be associated with an increased risk for a perioperative blood loss amount of ≥100 mL.

CONCLUSION

Compared with late-oxytocin administration, early-oxytocin administration could reduce perioperative blood loss during first-trimester suction curettage for missed abortion. However, the results require further investigation.