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Roth LM, Lee JH. Undue Burdens: State Abortion Laws in the United States, 1994-2022. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2023; 48:511-543. [PMID: 36693181 DOI: 10.1215/03616878-10449905] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
State laws have influenced access to abortion in the 50 years since Roe v. Wade. The 2022 Dobbs decision returned questions about the legality of abortion to the states, which increased the importance of state laws for abortion access. The objective of this study is to illustrate trends in abortion-restrictive and abortion-supportive state laws using a unique longitudinal database of reproductive health laws across the United States from 1994 to 2022. This study offers a descriptive analysis of historical trends in state-level pre-viability abortion bans, abortion method bans, efforts to dissuade abortion, TRAP (targeted regulation of abortion providers) laws, other laws that restrict reproductive choice, and laws that expand abortion access and support reproductive health. Data sources include state statutes (from Nexis Uni) and secondary sources. The data reveal that pre-viability bans, including gestation-based bans and total bans, became significantly more prevalent over time. Other abortion-restrictive laws increased from 1994 to 2022, but states also passed a growing number of laws that support reproductive health. Increasing polarization into abortion-restrictive and abortion-supportive states characterized the 1994-2022 period. These trends have implications for maternal and infant health and for racial/ethnic and income disparities.
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Gbagbo FY, Morhe RAS, Morhe EKS. Availability of Safe Second-Trimester Abortion Services in Health Facilities in Accra, Ghana. Matern Child Health J 2023; 27:850-860. [PMID: 36807234 DOI: 10.1007/s10995-023-03617-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2023] [Indexed: 02/20/2023]
Abstract
BACKGROUND We examined providers, methods employed, cost, and other determinants of availability of second-trimester abortion services in health facilities in Accra, Ghana in 2019 to inform policy and program decisions. METHODS A two-stage mixed quantitative and qualitative study designs were employed in the conduct of the study. The first stage was a short interaction of the mystery client with a clinical care provider to identify health facilities that provide second trimester induced abortion, the cost, and referral practices, where the facility did not have the service. The second stage was in-depth interviews of second-trimester abortion care providers and non-providers in various health facilities. For internal validity, it also explored the procedure cost, referral, and other practices at the health facilities included in the study, independent of what was captured in the mystery client survey. RESULTS Second-trimester abortion services in Accra, Ghana are widely unavailable even in most facilities that provided abortion services. Referral policies and practices indicated by the service providers at various facility levels were inadequate. Criminalization of the procedure, social stigma, and fear of complications are the main factors that adversely influence the availability of second-trimester abortion in health facilities in Accra. CONCLUSION Albeit increasing demand for second-trimester abortion in health facilities in Accra, services are not readily available due to the ambiguity of the law, its interpretation, and limited flow of accurate information on providers. Policies and programs that limit access to Second-trimester abortions in Ghana are amendable to ensure safe services.
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Affiliation(s)
- Fred Yao Gbagbo
- Faculty of Science Education, Department of Health Administration and Education, University of Education, Winneba, Ghana.
| | - Renee Aku Sitsofe Morhe
- Department of Private Law, Faculty of Law, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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The Use of Feticidal Agents Before Dilation and Evacuation or Induction of Labor for Later Abortion. Clin Obstet Gynecol 2022; 65:708-716. [PMID: 35293368 DOI: 10.1097/grf.0000000000000702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Abortion is a common medical procedure in the United States that is frequently the target of political and legal restrictions. These restrictions can negatively impact care and interfere with the patient-provider relationship. In this paper, we aim to review the historic context in which feticidal agents became more utilized in later abortion; describe current practices and protocols of using feticidal agents use for later abortion by dilation and evacuation and induction of labor; evaluate patient and provider perspectives on feticidal agent use; and propose areas of further ethical and research inquiry to characterize the use of these agents in later abortion procedures.
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Upadhyay UD, Weitz TA, Jones RK, Barar RE, Foster DG. Denial of Abortion Because of Provider Gestational Age Limits in the United States. Am J Public Health 2022; 112:1305-1312. [PMID: 35969817 PMCID: PMC9382160 DOI: 10.2105/ajph.2013.301378r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Mifepristone: A Safe Method of Medical Abortion and Self-Managed Medical Abortion in the Post-Roe Era. Am J Ther 2022; 29:e534-e543. [PMID: 35994387 DOI: 10.1097/mjt.0000000000001559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The U.S. Supreme Court's Dobbs v. Jackson Women's Health Organization decision on June 24, 2022 effectively overturned federal constitutional protections for abortion that have existed since 1973 and returned jurisdiction to the states. Several states implemented abortion bans, some of which banned abortion after 6 weeks and others that permit abortion under limited exceptions, such as if the health or the life of the woman is in danger. Other states introduced bills that define life as beginning at fertilization. As a result of these new and proposed laws, the future availability of mifepristone, one of two drugs used for medical abortion in the United States, has become the topic of intense debate and speculation. AREAS OF UNCERTAINTY Although its safety and effectiveness has been confirmed by many studies, the use of mifepristone has been politicized regularly since its approval. Areas of future study include mifepristone for induction termination and fetal demise in the third trimester and the management of leiomyoma. DATA SOURCES PubMed, Society of Family Planning, American College of Obstetrician and Gynecologists, the World Health Organization. THERAPEUTIC ADVANCES The use of no-touch medical abortion, which entails providing a medical abortion via a telehealth platform without a screening ultrasound or bloodwork, expanded during the COVID-19 pandemic, and studies have confirmed its safety. With the Dobbs decision, legal abortion will be less accessible and, consequently, self-managed abortion with mifepristone and misoprostol will become more prevalent. CONCLUSIONS Mifepristone and misoprostol are extremely safe medications with many applications. In the current changing political climate, physicians and pregnancy-capable individuals must have access to these medications.
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White K, Sierra G, Evans T, Roberts SCM. Abortion at 12 or more weeks' gestation and travel for later abortion care among Mississippi residents. Contraception 2022; 108:19-24. [PMID: 34971606 PMCID: PMC9036644 DOI: 10.1016/j.contraception.2021.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/21/2021] [Accepted: 11/23/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the association between indicators of economic disadvantage and geographic accessibility of reproductive health services and abortions ≥ 12 weeks' gestation in Mississippi. STUDY DESIGN This cross-sectional study used data on Mississippi residents who obtained abortion care from 12 of 14 facilities in Mississippi, Alabama, Louisiana, and Tennessee in 2018. We estimated logistic regression models to assess the association between levels of county deprivation, the number of obstetrician and/or gynecologists per 10,000 women, and one way distance to the nearest facility with having an abortion ≥ 12 weeks' gestation. We compared the median one-way distance to the facility where patients < 12 weeks', 12-15 weeks', and ≥ 16 weeks' gestation received care, using Kruskal-Wallis tests. RESULTS Of the 4,455 Mississippi residents who obtained abortions, 73% were Black, 59% lived ≥ 50 miles from a facility, and 60% obtained care in Mississippi. Overall, 764 (17.2%) abortions were performed ≥ 12 weeks' gestation. In adjusted models, those in counties with moderate (OR, 1.47; 95% CI: 1.15-1.90) and high (OR: 1.36, 95% CI: 1.01-1.83) (vs low) levels of economic deprivation and counties with 0.1-1.4 (vs ≥ 2.5) obstetrician/gynecologists per 10,000 women (OR: 1.55; 95% CI: 1.06-2.27) had higher odds of obtaining an abortion ≥12 weeks' gestation. Mississippi residents who obtained abortions ≥ 16 weeks' gestation traveled a median 143 miles one way to the facility where they received care, compared to 69 miles and 60 miles traveled by those < 12 weeks' and 12-15 weeks' gestation, respectively (p < .001). CONCLUSIONS Many Mississippi residents obtained abortion care ≥ 12 weeks' gestation, which is related to greater economic constraints and limited geographic access to reproductive health services. IMPLICATIONS People's need for abortions ≥ 12 weeks' gestation may be higher in communities with limited access to reproductive health services and among those living in areas with greater economic disadvantage. State laws that narrow gestational limits would increase long-distance travel for later abortion care, and disproportionately affect those with fewer resources.
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Affiliation(s)
- Kari White
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, United States; Population Research Center, The University of Texas at Austin, Austin, TX, United States.
| | - Gracia Sierra
- Population Research Center, The University of Texas at Austin, Austin, TX, United States.
| | - Teairra Evans
- Department of Psychology, University of Alabama, Tuscaloosa, AL, United States.
| | - Sarah C M Roberts
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, Oakland, CA, United States.
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Wolfe T, van der Meulen Rodgers Y. Abortion During the COVID-19 Pandemic: Racial Disparities and Barriers to Care in the USA. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2022; 19:541-548. [PMID: 33777258 PMCID: PMC7983965 DOI: 10.1007/s13178-021-00569-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/15/2021] [Indexed: 05/06/2023]
Abstract
This article draws on first-hand experience as well as scholarly research to illuminate how COVID-19 has impacted an already-embattled medical service in the USA, subsequently affecting the reproductive health and experiences of diverse individuals navigating an unfamiliar health and economic environment. COVID-19's introduction into a landscape of abortion restrictions has intensified the barriers that providers and communities already face, with disproportionate impacts on Black and Hispanic abortion seekers. Relaxing existing restrictions on medication abortions and telemedicine delivery models may be one way to ease the tension between keeping people home and getting them the treatment they need.
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Affiliation(s)
- Taida Wolfe
- Department of Women’s, Gender, and Sexuality Studies, Rutgers University, 162 Ryders Lane, New Brunswick, NJ 08901 USA
| | - Yana van der Meulen Rodgers
- Department of Women’s, Gender, and Sexuality Studies, Rutgers University, 162 Ryders Lane, New Brunswick, NJ 08901 USA
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Differences in Financial and Social Burdens Experienced by Patients Traveling for Abortion Care. Womens Health Issues 2021; 31:426-431. [PMID: 34266708 DOI: 10.1016/j.whi.2021.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 05/26/2021] [Accepted: 06/04/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE We compared perceived stress between women traveling 50 or fewer miles and more than 50 miles for abortion care. Secondary objectives were to compare individual-level stigma and hardship scores in patients by distance traveled to the clinic. METHODS We performed a cross-sectional study of patients presenting for care at an independent abortion clinic in southern Illinois. Participants completed a self-administered, tablet computer-based survey asking about their experiences seeking abortion, including the Perceived Stress Scale (PSS) and Individual Level Abortion Stigma (ILAS) scale. We created a composite score to characterize patient hardship regarding abortion care (range, 0-4). We examined responses stratified by the patients' self-reported one-way distance traveled to the clinic (group 1, ≤50 miles; group 2, >50 miles). RESULTS A total of 308 women completed the survey. There was no significant difference in mean PSS scores (p = .71) or median ILAS scores (p = .40) between groups. A majority of the cohort reported moderate or high stress (68.2%). The median hardship score was significantly higher in the greater than 50 mile group (median, 1 [interquartile range, 0-2] vs. 2 [interquartile range 1-3]; p < .001). Patients who traveled more than 50 miles reported difficulties related to missing work (58.3%), delays in obtaining an abortion owing to financial costs (35.7%), lodging (13.9%), and transportation (11.3%). CONCLUSIONS There was no difference in PSS or ILAS scores by distance traveled among patients seeking an abortion; however, patients who traveled more than 50 miles had a higher hardship score, suggesting greater difficulty accessing abortion. The most common difficulties encountered included missing time from work and financial costs associated with the abortion.
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Coast E, Lattof SR, van der Meulen Rodgers Y, Moore B, Poss C. The microeconomics of abortion: A scoping review and analysis of the economic consequences for abortion care-seekers. PLoS One 2021; 16:e0252005. [PMID: 34106927 PMCID: PMC8189560 DOI: 10.1371/journal.pone.0252005] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 05/10/2021] [Indexed: 11/19/2022] Open
Abstract
Background The economic consequences of abortion care and abortion policies for
individuals occur directly and indirectly. We lack synthesis of the economic
costs, impacts, benefit or value of abortion care at the micro-level (i.e.,
individuals and households). This scoping review examines the microeconomic
costs, benefits and consequences of abortion care and policies. Methods and findings Searches were conducted in eight electronic databases and applied
inclusion/exclusion criteria using the PRISMA extension for Scoping Reviews.
For inclusion, studies must have examined at least one of the following
outcomes: costs, impacts, benefits, and value of abortion care or abortion
policies. Quantitative and qualitative data were extracted for descriptive
statistics and thematic analysis. Of the 230 included microeconomic studies,
costs are the most frequently reported microeconomic outcome (n = 180),
followed by impacts (n = 84), benefits (n = 39), and values (n = 26).
Individual-level costs of abortion-related care have implications for the
timing and type of care sought, globally. In contexts requiring multiple
referrals or follow-up visits, these costs are multiplied. The ways in which
people pay for abortion-related costs are diverse. The intersection between
micro-level costs and delay(s) to abortion-related care is substantial.
Individuals forego other costs and expenditures, or are pushed further into
debt and/or poverty, in order to fund abortion-related care. The evidence
base on the economic impacts of policy or law change is from high-income
countries, dominated by studies from the United States. Conclusions Delays underpinned by economic factors can thwart care-seeking, affect the
type of care sought, and impact the gestational age at which care is sought
or reached. The evidence base includes little evidence on the micro-level
costs for adolescents. Specific sub-groups of abortion care-seekers
(transgendered and/or disabled people) are absent from the evidence and it
is likely that they may experience higher direct and indirect costs because
they may experience greater barriers to abortion care.
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Affiliation(s)
- Ernestina Coast
- Department of International Development, London School of Economics and
Political Science, London, United Kingdom
- * E-mail:
| | - Samantha R. Lattof
- Department of International Development, London School of Economics and
Political Science, London, United Kingdom
| | - Yana van der Meulen Rodgers
- Department of Labor Studies and Employment Relations, Rutgers University,
Piscataway, New Jersey, United States of America
- Department of Women’s and Gender Studies, Rutgers University, Piscataway,
New Jersey, United States of America
| | - Brittany Moore
- Ipas, Chapel Hill, North Carolina, United States of
America
| | - Cheri Poss
- Ipas, Chapel Hill, North Carolina, United States of
America
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Rodgers YVDM, Coast E, Lattof SR, Poss C, Moore B. The macroeconomics of abortion: A scoping review and analysis of the costs and outcomes. PLoS One 2021; 16:e0250692. [PMID: 33956826 PMCID: PMC8101771 DOI: 10.1371/journal.pone.0250692] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 03/25/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Although abortion is a common gynecological procedure around the globe, we lack synthesis of the known macroeconomic costs and outcomes of abortion care and abortion policies. This scoping review synthesizes the literature on the impact of abortion-related care and abortion policies on economic outcomes at the macroeconomic level (that is, for societies and nation states). METHODS AND FINDINGS Searches were conducted in eight electronic databases. We conducted the searches and application of inclusion/exclusion criteria using the PRISMA extension for Scoping Reviews. For inclusion, studies must have examined one of the following macroeconomic outcomes: costs, impacts, benefits, and/or value of abortion care or abortion policies. Quantitative and qualitative data were extracted for descriptive statistics and thematic analysis. Of the 189 data extractions with macroeconomic evidence, costs at the national level are the most frequently reported economic outcome (n = 97), followed by impacts (n = 66), and benefits/value (n = 26). Findings show that post-abortion care services can constitute a substantial portion of national expenditures on health. Public sector coverage of abortion costs is sparse, and individuals bear most of the costs. Evidence also indicates that liberalizing abortion laws can have positive spillover effects for women's educational attainment and labor supply, and that access to abortion services contributes to improvements in children's human capital. However, the political economy around abortion legislation remains complicated and controversial. CONCLUSIONS Given the highly charged political nature of abortion around the global and the preponderance of rhetoric that can cloud reality in policy dialogues, it is imperative that social science researchers build the evidence base on the macroeconomic outcomes of abortion services and regulations.
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Affiliation(s)
- Yana van der Meulen Rodgers
- Department of Labor Studies and Employment Relations, Rutgers University, Piscataway, New Jersey, United States of America
- Department of Women’s and Gender Studies, Rutgers University, Piscataway, New Jersey, United States of America
| | - Ernestina Coast
- Department of International Development, London School of Economics and Political Science, London, United Kingdom
| | - Samantha R. Lattof
- Department of International Development, London School of Economics and Political Science, London, United Kingdom
| | - Cheri Poss
- Ipas, Chapel Hill, North Carolina, United States of America
| | - Brittany Moore
- Ipas, Chapel Hill, North Carolina, United States of America
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Lattof SR, Coast E, Rodgers YVDM, Moore B, Poss C. The mesoeconomics of abortion: A scoping review and analysis of the economic effects of abortion on health systems. PLoS One 2020; 15:e0237227. [PMID: 33147223 PMCID: PMC7641432 DOI: 10.1371/journal.pone.0237227] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 07/08/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Despite the high incidence of abortion around the globe, we lack synthesis of the known economic consequences of abortion care and abortion policies at the mesoeconomic level (i.e. health systems and communities). This scoping review examines the mesoeconomic costs, benefits, impacts, and values of abortion care and policies. METHODS AND FINDINGS Searches were conducted in eight electronic databases. We conducted the searches and application of inclusion/exclusion criteria using the PRISMA extension for Scoping Reviews. For inclusion, studies must have examined at least one of the following outcomes: costs, benefits, impacts, and value of abortion care or abortion policies. Quantitative and qualitative data were extracted for descriptive statistics and thematic analysis. Of the 150 included mesoeconomic studies, costs to health systems are the most frequently reported mesoeconomic outcome (n = 116), followed by impacts (n = 40), benefits (n = 17), and values (n = 11). Within health facilities and health systems, the costs of providing abortion services vary greatly, particularly given the range with which researchers identify and cost services. Financial savings can be realized while maintaining or even improving quality of abortion services. Adapting to changing laws and policies is costly for health facilities. American policies on abortion economically impact health systems and facilities both domestically and abroad. Providing post-abortion care requires a disproportionate amount of health facility resources. CONCLUSIONS The evidence base has consolidated around abortion costs to health systems and health facilities in high-income countries more than in low- or middle-income countries. Little is known about the economic impacts of abortion on communities or the mesoeconomics of abortion in the Middle East and North Africa. Methodologically, review papers are the most frequent study type, indicating that researchers rely on evidence from a core set of costing papers. Studies generating new primary data on mesoeconomic outcomes are needed to strengthen the evidence base.
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Affiliation(s)
- Samantha R. Lattof
- Department of International Development, London School of Economics and Political Science, London, United Kingdom
| | - Ernestina Coast
- Department of International Development, London School of Economics and Political Science, London, United Kingdom
| | - Yana van der Meulen Rodgers
- Department of Labor Studies and Employment Relations, Rutgers University, Piscataway, New Jersey, United States of America
- Department of Women’s and Gender Studies, Rutgers University, Piscataway, New Jersey, United States of America
| | - Brittany Moore
- Ipas, Chapel Hill, North Carolina, United States of America
| | - Cheri Poss
- Ipas, Chapel Hill, North Carolina, United States of America
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Leslie DL, Liu G, Jones BS, Roberts SCM. Healthcare costs for abortions performed in ambulatory surgery centers vs office-based settings. Am J Obstet Gynecol 2020; 222:348.e1-348.e9. [PMID: 31629727 DOI: 10.1016/j.ajog.2019.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 09/06/2019] [Accepted: 10/12/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Several states require that abortions be provided in ambulatory surgery centers. Supporters of such laws argue that they make abortions safer, yet previous studies have found no differences in abortion-related morbidities or adverse events for abortions performed in ambulatory surgery centers versus office-based settings. However, little is known about how costs of abortions provided in ambulatory surgery centers differ from those provided in office-based settings. OBJECTIVE To compare healthcare expenditures for abortions performed in ambulatory surgery centers versus office-based settings using a large national private insurance claims database. MATERIALS AND METHODS A retrospective cohort study compared expenditures for abortions performed in ambulatory surgery centers versus office-based settings. Data on women who had abortions in an ambulatory surgery center or office-based setting between January 1, 2011, and December 31, 2014 were obtained from the MarketScan Commercial Claims and Encounters database. The sample was limited to women who were continuously enrolled in their insurance plans for at least 1 year before and at least 6 weeks after the abortion. Healthcare expenditures were assessed separately for the index abortion and the 6-week period after the abortion. Costs were measured from the perspective of the healthcare system and included all payments to the provider, including insurance company payments and any patient out-of-pocket payments. RESULTS Overall, 49,287 beneficiaries who had 50,311 abortions met inclusion criteria. Of the included abortions, 47% were first-trimester aspiration, 27% first-trimester medication, and 26% second-trimester or later abortions. Most abortions (89%) were provided in office-based settings, with 11% provided in ambulatory surgery centers. Unadjusted mean index abortion costs were higher in ambulatory surgery centers than in office-based settings ($1704 versus $810; P < .001). After adjusting for patient clinical and demographic characteristics, costs of index abortions were $772 higher (95% confidence interval, $746-$797), total follow-up costs for abortions that had any follow-up care were $1099 higher (95% confidence interval, $1004-$1,195), and total follow-up costs for abortions that had an abortion-related morbidity or adverse event were not significantly different in ambulatory surgery centers compared to office-based settings. There were also no significant differences in the likelihood of having any follow-up care or abortion-related event follow-up care. CONCLUSION Abortions performed at ambulatory surgery centers are significantly more costly than those performed in office-based settings, with no difference in the likelihood of receiving follow-up care. Laws requiring that abortions be provided in ambulatory surgery centers may only result in increased costs for abortions, with no effect on abortion safety.
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Affiliation(s)
- Douglas L Leslie
- Center for Applied Studies in Health Economics, Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA.
| | - Guodong Liu
- Center for Applied Studies in Health Economics, Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Bonnie Scott Jones
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA
| | - Sarah C M Roberts
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA
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Ostrach B. Publicly Funded Abortion and Marginalised People’s Experiences in Catalunya. ANTHROPOLOGY IN ACTION 2020. [DOI: 10.3167/aia.2020.270103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abortion law reforms enacted in Spain in 2010 and extended to Catalunya expanded access to abortion. Simultaneously, the autonomous region was affected by economic crisis and austerity, affecting access to care for migrant and marginalised populations. Mixed-method ethnographic data were collected in relation to low-income and immigrant women seeking abortion in two phases: (1) 2012–2013 and (2) early 2016. Data sources included surveys, interviews and participant observation. Data analysis combined descriptive statistics, modified Grounded Theory, thematic analysis and constant comparative methods. Despite public funding of care in a system ostensibly available to all, marginalised people seeking abortion reported reduced access and more barriers to access. Participant experiences with legal, publicly funded abortion revealed bureaucratic difficulties and delays as well as inconsistent and inadequate information. Data on marginalised people’s experiences demonstrate that even where abortion is legal and ostensibly available, politico-economic contexts and trends affect their access to abortion and public health care.
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Roberts SCM, Upadhyay UD, Liu G, Kerns JL, Ba D, Beam N, Leslie DL. Association of Facility Type With Procedural-Related Morbidities and Adverse Events Among Patients Undergoing Induced Abortions. JAMA 2018; 319:2497-2506. [PMID: 29946727 PMCID: PMC6583042 DOI: 10.1001/jama.2018.7675] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Multiple states have laws requiring abortion facilities to meet ambulatory surgery center (ASC) standards. There is limited evidence regarding abortion-related morbidities and adverse events following abortions performed at ASCs vs office-based settings. OBJECTIVE To compare abortion-related morbidities and adverse events at ASCs vs office-based settings. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study of women with US private health insurance who underwent induced abortions in an ASC or office-based setting (January 1, 2011-December 31, 2014). Outcomes were abstracted from a large national private insurance claims database during the 6 weeks following the abortion (date of final follow-up, February 11, 2015). EXPOSURES Facility type for abortion (ASCs vs office-based settings, including facilities such as abortion clinics, nonspecialized clinics, and physician offices). MAIN OUTCOMES AND MEASURES The primary outcome was any abortion-related morbidity or adverse event (such as retained products of conception, abortion-related infection, hemorrhage, and uterine perforation) within 6 weeks after an abortion. Two secondary outcomes, both subsets of the primary outcome, were major abortion-related morbidities and adverse events (such as hemorrhages treated with a transfusion, missed ectopic pregnancies treated with surgery, and abortion-related infections that resulted in an overnight hospital admission) and abortion-related infections. RESULTS Among 49 287 women (mean age, 28 years [SD, 7.3]) who had 50 311 induced abortions, (23 891 [47%] first-trimester aspiration, 13 480 [27%] first-trimester medication, and 12 940 [26%] second trimester or later), 5660 abortions (11%) were performed in ASCs and 44 651 (89%) in office-based settings. Overall, 3.33% had an abortion-related morbidity or adverse event; 0.32% had a major abortion-related morbidity or adverse event; and 0.74% had an abortion-related infection. In adjusted analyses, there was no statistically significant difference between ASCs vs office-based settings, respectively, in the rates of abortion-related morbidities or adverse events (3.25% vs 3.33%, difference, -0.08%; [corrected] 95% CI, -0.58% to 0.43%; adjusted OR, 0.97; 95% CI, 0.81-1.17), major morbidities or adverse events (0.26% vs 0.33%; difference, -0.06%; 95% CI, -0.18% to 0.06%; adjusted OR, 0.78; 95% CI, 0.45-1.37), or infections (0.58% vs 0.77%; difference, -0.16%; 95% CI, -0.35% to 0.03%; adjusted OR, 0.75; 95% CI, 0.52-1.09). CONCLUSIONS AND RELEVANCE Among women with private health insurance who had an induced abortion, performance of the abortion in an ambulatory surgical center compared with an office-based setting was not associated with a significant difference in abortion-related morbidities and adverse events. These findings, in addition to individual patient and individual facility factors, may inform decisions about the type of facility in which induced abortions are performed.
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Affiliation(s)
- Sarah C. M. Roberts
- 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
| | - Ushma D. Upadhyay
- 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
| | - Guodong Liu
- Center for Applied Studies in Health Economics, Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Jennifer L. Kerns
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco
| | - Djibril Ba
- Center for Applied Studies in Health Economics, Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Nancy Beam
- 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
| | - Douglas L. Leslie
- Center for Applied Studies in Health Economics, Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
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Jones BS, Daniel S, Cloud LK. State Law Approaches to Facility Regulation of Abortion and Other Office Interventions. Am J Public Health 2018; 108:486-492. [PMID: 29470114 DOI: 10.2105/ajph.2017.304278] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To compare the prevalence and characteristics of facility laws governing abortion provision specifically (targeted regulation of abortion providers [TRAP] laws); office-based surgeries, procedures, sedation or anesthesia (office interventions) generally (OBS laws); and other procedures specifically. METHODS We conducted cross-sectional legal assessments of state facility laws for office interventions in effect as of August 1, 2016. We coded characteristics for each law and compared characteristics across categories of laws. RESULTS TRAP laws (n = 55; in 34 states) were more prevalent than OBS laws (n = 25; in 25 states) or laws targeting other procedures (n = 1; in 1 state). TRAP laws often regulated facilities that would not be regulated under OBS laws (e.g., all TRAP laws, but only 2 OBS laws, applied regardless of sedation or anesthesia used). TRAP laws imposed more numerous and more stringent requirements than OBS laws. CONCLUSIONS Many states regulate abortion-providing facilities differently, and more stringently, than facilities providing other office interventions. The Supreme Court's 2016 decision in Whole Woman's Health v Hellerstedt casts doubt on the legitimacy of that differential treatment.
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Affiliation(s)
- Bonnie S Jones
- Bonnie S. Jones and Sara Daniel are with Advancing New Standards in Reproductive Health, University of California, San Francisco, Oakland. Lindsay K. Cloud is with the Policy Surveillance Program of the Center for Public Health Law Research, Temple University, Philadelphia, PA
| | - Sara Daniel
- Bonnie S. Jones and Sara Daniel are with Advancing New Standards in Reproductive Health, University of California, San Francisco, Oakland. Lindsay K. Cloud is with the Policy Surveillance Program of the Center for Public Health Law Research, Temple University, Philadelphia, PA
| | - Lindsay K Cloud
- Bonnie S. Jones and Sara Daniel are with Advancing New Standards in Reproductive Health, University of California, San Francisco, Oakland. Lindsay K. Cloud is with the Policy Surveillance Program of the Center for Public Health Law Research, Temple University, Philadelphia, PA
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Blanchard K, Meadows JL, Gutierrez HR, Hannum CP, Douglas-Durham EF, Dennis AJ. Mixed-methods investigation of women's experiences with second-trimester abortion care in the Midwest and Northeast United States. Contraception 2017; 96:401-410. [PMID: 28867439 DOI: 10.1016/j.contraception.2017.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 08/21/2017] [Accepted: 08/23/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE(S) We studied women's experiences seeking and receiving second-trimester abortion care in two geographically and legislatively different settings to inform ways to improve abortion care access and services. STUDY DESIGN We conducted in-depth interviews with women who obtained second-trimester abortion care. Themes from the interviews were then used to inform a self-administered survey, which was completed by 108 women who received second-trimester abortion care in the Northeast and Midwest. We calculated descriptive statistics and used chi-squared and t-tests to compare responses. RESULTS We interviewed eight women and surveyed 108 women. Most interviewees and 65.2% of survey respondents reported difficulties accessing care. Although most interview and survey respondents had insurance, a slight majority reported difficulty funding care. All interviewees and 57.9% of survey respondents reported positive experiences with providers, with many interviewees and 62.0% of survey respondents saying their abortion care was better than their usual health care. Most interviewees and 75.8% of survey respondents reported pain as low to moderate, and the majority of participants reported it was the same or less than expected. Knowledge about abortion restrictions was low. Most interviewees and 68.4% survey respondents disagreed with restrictions on insurance coverage of abortion. Common recommendations to improve experiences were to ensure travel and financial support and to decrease wait times at clinics. There were few regional differences among outcomes. CONCLUSION(S) Women seeking second-trimester abortion in these locations reported positive abortion experiences. However, they had to overcome significant obstacles to obtain care. IMPLICATIONS This is the first study to systematically research women's second-trimester care experiences in two different regions of the United States. Regardless of location, women experienced barriers due to policies that impose gestational age restrictions, limit provider availability (consequently increasing wait times), and increase costs. Policy change to reduce these barriers is critical to improve access to and experiences with second trimester abortion care.
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Affiliation(s)
- Kelly Blanchard
- Ibis Reproductive Health, 2067 Massachusetts Avenue, #320, Cambridge, MA 02140, USA.
| | - Jill L Meadows
- Planned Parenthood of the Heartland, 1171 7th Street, Des Moines, IA 50314, USA
| | - Hialy R Gutierrez
- Ibis Reproductive Health, 2067 Massachusetts Avenue, #320, Cambridge, MA 02140, USA
| | - Curtiss Ps Hannum
- The Women's Centers, 777 Appletree Street, 7th Floor, Philadelphia, PA 19106, USA
| | | | - Amanda J Dennis
- Ibis Reproductive Health, 2067 Massachusetts Avenue, #320, Cambridge, MA 02140, USA
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Ely GE, Hales T, Jackson DL, Bowen EA, Maguin E, Hamilton G. A trauma-informed examination of the hardships experienced by abortion fund patients in the United States. Health Care Women Int 2017; 38:1133-1151. [PMID: 28850325 DOI: 10.1080/07399332.2017.1367795] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Researchers describe hardships experienced by abortion patients, examining administrative health cases from 2010 to 2015 in the United States. All patients received financial assistance from an abortion fund to help pay for abortion. Case data were analyzed to assess types and numbers of hardships experienced by age, race, and geographic origin. Hardships ranged from homelessness to parenting multiple children. Patients from the geographic South experienced the most hardships, followed by those from the Midwest. Hardships experienced by abortion fund patients are like those reported in other samples of abortion patients; hardships potentially cause or exacerbate trauma. Results are discussed in the context of a trauma-informed perspective.
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Affiliation(s)
- Gretchen E Ely
- a School of Social Work , University at Buffalo, The State University of New York , Buffalo , New York , USA
| | - Travis Hales
- a School of Social Work , University at Buffalo, The State University of New York , Buffalo , New York , USA
| | - D Lynn Jackson
- b Department of Social Work , Texas Christian University , Fort Worth , Texas , USA
| | - Elizabeth A Bowen
- a School of Social Work , University at Buffalo, The State University of New York , Buffalo , New York , USA
| | - Eugene Maguin
- a School of Social Work , University at Buffalo, The State University of New York , Buffalo , New York , USA
| | - Greer Hamilton
- a School of Social Work , University at Buffalo, The State University of New York , Buffalo , New York , USA
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Zurbriggen R, Keefe-Oates B, Gerdts C. Accompaniment of second-trimester abortions: the model of the feminist Socorrista network of Argentina. Contraception 2017; 97:108-115. [PMID: 28801052 DOI: 10.1016/j.contraception.2017.07.170] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 07/02/2017] [Accepted: 07/29/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Legal restrictions on abortion access impact the safety and timing of abortion. Women affected by these laws face barriers to safe care that often result in abortion being delayed. Second-trimester abortion affects vulnerable groups of women disproportionately and is often more difficult to access. In Argentina, where abortion is legally restricted except in cases of rape or threat to the health of the woman, the Socorristas en Red, a feminist network, offers a model of accompaniment wherein they provide information and support to women seeking second-trimester abortions. This qualitative analysis aimed to understand Socorristas' experiences supporting women who have second-trimester medication abortion outside the formal health care system. STUDY DESIGN We conducted 2 focus groups with 16 Socorristas in total to understand experiences accompanying women having second-trimester medication abortion who were at 14-24 weeks' gestational age. We performed a thematic analysis of the data and present key themes in this article. RESULTS The Socorristas strived to ensure that women had the power of choice in every step of their abortion. These cases required more attention and logistical, legal and medical risks than first-trimester care. The Socorristas learned how to help women manage the possibility of these risks and were comfortable providing this support. They understood their work as activism through which they aim to destigmatize abortion and advocate against patriarchal systems denying the right to abortion. CONCLUSION Socorrista groups have shown that they can provide supportive, women-centered accompaniment during second-trimester medication abortions outside the formal health care system in a setting where abortion access is legally restricted. IMPLICATIONS Second-trimester self-use of medication abortion outside of the formal health system supported by feminist activist groups could provide an alternative model for second-trimester care worldwide. More research is needed to document the safety and effectiveness of this accompaniment service-provision model.
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Affiliation(s)
| | - Brianna Keefe-Oates
- Ibis Reproductive Health, 1330 Broadway Street, Suite 1100, Oakland, CA 94612, USA.
| | - Caitlin Gerdts
- Ibis Reproductive Health, 1330 Broadway Street, Suite 1100, Oakland, CA 94612, USA.
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Implications of Ohio's 20-Week Abortion Ban on Prenatal Patients and the Assessment of Fetal Anomalies. Obstet Gynecol 2017; 129:795-799. [DOI: 10.1097/aog.0000000000001996] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Quast T, Gonzalez F, Ziemba R. Abortion Facility Closings and Abortion Rates in Texas. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2017; 54:46958017700944. [PMID: 28351188 PMCID: PMC5798726 DOI: 10.1177/0046958017700944] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
From 2004 to 2014, the overall abortion rate in Texas fell by almost a third from 10.7 to 7.2 abortions per 1000 women aged 10 to 49 years. During this same period, the number of abortion clinics operating at least 6 months in the year fell from 40 to 27. We examined the relationship between the abortion rate and the proximity of abortion facilities. We matched annual, county-level data on abortion rates in Texas from 2004 through 2014 with the distance from the county centroids to the nearest abortion facility in operation. Linear regressions were used to estimate the association between abortion rates and proximity to abortion facilities. The regressions controlled for county-level and state-level characteristics as well as the availability of abortion services in neighboring US states and Mexico. We found that a 100-mile increase in distance to the nearest abortion facility was associated with a 10% decrease in the overall abortion rate. The relationship appeared to be driven largely by distances of 200 miles or more. The overall relationship was generally present for whites and blacks, whereas the pattern was less clear for Hispanics. The analysis indicated that the overall association was driven largely by women aged 20 to 34 years. Decreased access to abortion facilities was associated with decreases in the abortion rate, yet the relationship varied by race/ethnicity and age. As such, regulations that affect the operational status of abortion facilities likely have differential effects on women.
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Affiliation(s)
- Troy Quast
- 1 University of South Florida, Tampa, USA
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Keogh LA, Newton D, Bayly C, McNamee K, Hardiman A, Webster A, Bismark M. Intended and unintended consequences of abortion law reform: perspectives of abortion experts in Victoria, Australia. ACTA ACUST UNITED AC 2016; 43:18-24. [PMID: 27913574 DOI: 10.1136/jfprhc-2016-101541] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/07/2016] [Accepted: 11/07/2016] [Indexed: 11/04/2022]
Abstract
INTRODUCTION In Victoria, Australia, abortion was decriminalised in October 2008, bringing the law in line with clinical practice and community attitudes. We describe how experts in abortion service provision perceived the intent and subsequent impact of the 2008 Victorian abortion law reform. METHODS Experts in abortion provision in Victoria were recruited for a qualitative semi-structured interview about the 2008 law reform and its perceived impact, until saturation was reached. Nineteen experts from a range of health care settings and geographic locations were interviewed in 2014/2015. Thematic analysis was conducted to summarise participants' views. RESULTS Abortion law reform, while a positive event, was perceived to have changed little about the provision of abortion. The views of participants can be categorised into: (1) goals that law reform was intended to address and that have been achieved; (2) intent or hopes of law reform that have not been achieved; (3) unintended consequences; (4) coincidences; and (5) unfinished business. All agreed that law reform had repositioned abortion as a health rather than legal issue, had shifted the power in decision making from doctors to women, and had increased clarity and safety for doctors. However, all described outstanding concerns; limited public provision of surgical abortion; reduced access to abortion after 20 weeks; ongoing stigma; lack of a state-wide strategy for equitable abortion provision; and an unsustainable workforce. CONCLUSION Law reform, while positive, has failed to address a number of significant issues in abortion service provision, and may have even resulted in a 'lull' in action.
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Affiliation(s)
- L A Keogh
- Associate Professor, Gender and Women's Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - D Newton
- Research Fellow, Gender and Women's Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - C Bayly
- Senior Clinical Adviser, Women's Health, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - K McNamee
- Medical Director, Family Planning Victoria, Melbourne, Victoria, Australia
| | - A Hardiman
- Manager, Pregnancy Advisory Service, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - A Webster
- Senior Policy and Health Promotion Officer, Women's Health Victoria, Melbourne, Victoria, Australia
| | - M Bismark
- Associate Professor of Law and Public Health, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Mitchell LM. “Time with Babe”: Seeing Fetal Remains after Pregnancy Termination for Impairment. Med Anthropol Q 2016; 30:168-85. [DOI: 10.1111/maq.12173] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sawicki NN. MANDATING DISCLOSURE OF CONSCIENCE-BASED LIMITATIONS ON MEDICAL PRACTICE. AMERICAN JOURNAL OF LAW & MEDICINE 2016; 42:85-128. [PMID: 27263264 DOI: 10.1177/0098858816644717] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Stakeholders in law, medicine, and religion are unable to reach consensus about how best to address conflicts between healthcare providers' conscientious objections to treatment and patients' rights to access medical care. Conscience laws that protect objecting providers and institutions from liability are criticized as too broad by patient advocates and as too narrow by defenders of religious freedom. This Article posits that some of the tension between these stakeholders could be mitigated by statutory recognition of a duty on the part of healthcare institutions or providers to disclose conscientiously motivated limitations on practice. While this solution would not guarantee a patient's access to treatment, referral, or information from any given provider, it would prevent some of the more egregious cases of denial of treatment--those where patients are not made aware that a legal and clinically defensible treatment option is excluded from a provider's or institution's scope of practice and so have no opportunity to seek care elsewhere.
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Karasek D, Roberts SCM, Weitz TA. Abortion Patients' Experience and Perceptions of Waiting Periods: Survey Evidence before Arizona's Two-visit 24-hour Mandatory Waiting Period Law. Womens Health Issues 2015; 26:60-6. [PMID: 26626710 DOI: 10.1016/j.whi.2015.10.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 10/13/2015] [Accepted: 10/13/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND More than one-half of U.S. states now have laws requiring women to wait at least 24 hours between receiving information about abortion and the actual abortion procedure, with a few requiring longer waits, and one-fourth requiring that women receive this information in person. Although public discussions of waiting periods focus on how they affect women, we know little about abortion patients' perceptions of these requirements. METHODS We collected data from 379 women seeking abortion care at an abortion facility in Arizona before Arizona's 24-hour waiting period two-visit requirement went into effect. Surveys focused on patients' experiences receiving abortion care before the waiting period and perceptions about how the additional clinic visit would affect them. RESULTS Most women reported one or more financial or logistical challenges in obtaining abortion care. More than two-thirds reported difficulty paying abortion appointment-related expenses. These expenses prevented or delayed almost one-half from paying other expenses, such as rent, bills, and food, with lower income women more affected. The majority expected that the additional visit would result in additional financial and logistical hardships and delay them in having an abortion, with 90% reporting that the waiting period would lead to at least one hardship. Eight percent reported that the waiting period would have a positive effect on emotional well-being, and more than one-half reported that it would have a negative effect on emotional well-being. CONCLUSION Only a small minority of women seeking abortion care view a two-visit waiting period law as benefiting them; the overwhelming majority expect a waiting period to have adverse consequences.
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Affiliation(s)
- Deborah Karasek
- Bixby Center for Global Reproductive Health, Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, Oakland, California.
| | - Sarah C M Roberts
- Bixby Center for Global Reproductive Health, Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, Oakland, California
| | - Tracy A Weitz
- Bixby Center for Global Reproductive Health, Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, Oakland, California
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A Qualitative Exploration of Low-Income Women's Experiences Accessing Abortion in Massachusetts. Womens Health Issues 2015; 25:463-9. [DOI: 10.1016/j.whi.2015.04.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 04/03/2015] [Accepted: 04/10/2015] [Indexed: 01/23/2023]
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Mercier RJ, Buchbinder M, Bryant A. TRAP laws and the invisible labor of US abortion providers. CRITICAL PUBLIC HEALTH 2015; 26:77-87. [PMID: 27570376 DOI: 10.1080/09581596.2015.1077205] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Targeted Regulations of Abortion Providers (TRAP laws) are proliferating in the United States and have increased barriers to abortion access. In order to comply with these laws, abortion providers make significant changes to facilities and clinical practices. In this article, we draw attention to an often unacknowledged area of public health threat: how providers adapt to increasing regulation, and the resultant strains on the abortion provider workforce. Current US legal standards for abortion regulations have led to an increase in laws that target abortion providers. We describe recent research with abortion providers in North Carolina to illustrate how providers adapt to new regulations, and how compliance with regulation leads to increased workload and increased financial and emotional burdens on providers. We use the concept of invisible labor to highlight the critical work undertaken by abortion providers not only to comply with regulations, but also to minimize the burden that new laws impose on patients. This labor provides a crucial bridge in the preservation of abortion access. The impact of TRAP laws on abortion providers should be included in the consideration of the public health impact of abortion laws.
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Affiliation(s)
- Rebecca J Mercier
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia PA 19107 United States
| | - Mara Buchbinder
- Department of Social Medicine, University of North Carolina at Chapel Hill, 341A MacNider Hall CB 7240, Chapel Hill, NC 27599 United States
| | - Amy Bryant
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, 4002 Old Clinic Building, CB 7570, Chapel Hill, NC 27599 United States
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Purcell C, Cameron S, Caird L, Flett G, Laird G, Melville C, McDaid LM. Access to and experience of later abortion: accounts from women in Scotland. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2014; 46:101-108. [PMID: 24785904 DOI: 10.1363/46e1214] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
CONTEXT Except in the presence of significant medical indications, the legal limit for abortion in Great Britain is 24 weeks' gestation. Nevertheless, abortion for nonmedical reasons is not usually provided in Scotland after 18-20 weeks, meaning women have to travel to England for the procedure. METHODS In-depth interviews were conducted with 23 women presenting for "later" abortions (i.e., at 16 or more weeks' gestation) in Scotland. Participants were women who sought an abortion at a participating National Health Service clinic between January and July 2013. Interviews addressed reasons for and consequences of later presentation, as well as women's experiences of abortion. Thematic analysis attended to emerging issues and employed the conceptual tool of candidacy. RESULTS Delayed recognition of pregnancy, changed life circumstances and conflicting candidacies for motherhood and having an abortion were common reasons for women's presentation for later abortion. Women perceived that the resources required to travel to England for a later abortion were potential barriers to access, and felt that such travel was distressing and stigmatizing. Participants who continued their pregnancy did so after learning they were at a later gestational age than expected or after receiving assurances of support from partners, friends or family. CONCLUSIONS Reasons for seeking later abortion are complex and varied among women in Scotland, and suggest that reducing barriers to access and improving local provision of such abortions are a necessity. The candidacy framework allows for a fuller understanding of the difficulties involved in obtaining abortions.
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Affiliation(s)
- Carrie Purcell
- Centre for Population Health Sciences, Medical School, University of Edinburgh, Edinburgh, United Kingdom.
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Dehlendorf C, Harris LH, Weitz TA. Disparities in abortion rates: a public health approach. Am J Public Health 2013; 103:1772-9. [PMID: 23948010 PMCID: PMC3780732 DOI: 10.2105/ajph.2013.301339] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2013] [Indexed: 12/23/2022]
Abstract
Women of lower socioeconomic status and women of color in the United States have higher rates of abortion than women of higher socioeconomic status and White women. Opponents of abortion use these statistics to argue that abortion providers are exploiting women of color and low socioeconomic status, and thus, regulations are needed to protect women. This argument ignores the underlying causes of the disparities. As efforts to restrict abortion will have no effect on these underlying factors, and instead will only result in more women experiencing later abortions or having an unintended childbirth, they are likely to result in worsening health disparities. We provide a review of the causes of abortion disparities and argue for a multifaceted public health approach to address them.
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Affiliation(s)
- Christine Dehlendorf
- Christine Dehlendorf is with the Departments of Family and Community Medicine, Obstetrics, Gynecology and Reproductive Sciences, and Epidemiology and Biostatistics at the University of California, San Francisco. Lisa H. Harris is with the Departments of Obstetrics and Gynecology and Women's Studies, University of Michigan, Ann Arbor. Tracy A. Weitz is with Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, University of California, San Francisco
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Upadhyay UD, Weitz TA, Jones RK, Barar RE, Foster DG. Denial of abortion because of provider gestational age limits in the United States. Am J Public Health 2013; 104:1687-94. [PMID: 23948000 DOI: 10.2105/ajph.2013.301378] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the factors influencing delay in seeking abortion and the outcomes for women denied abortion care because of gestational age limits at abortion facilities. METHODS We compared women who presented for abortion care who were under the facilities' gestational age limits and received an abortion (n = 452) with those who were just over the gestational age limits and were denied an abortion (n = 231) at 30 US facilities. We described reasons for delay in seeking services. We examined the determinants of obtaining an abortion elsewhere after being denied one because of facility gestational age limits. We then estimated the national incidence of being denied an abortion because of facility gestational age limits. RESULTS Adolescents and women who did not recognize their pregnancies early were most likely to delay seeking care. The most common reason for delay was having to raise money for travel and procedure costs. We estimated that each year more than 4000 US women are denied an abortion because of facility gestational limits and must carry unwanted pregnancies to term. CONCLUSIONS Many state laws restrict abortions based on gestational age, and new laws are lowering limits further. The incidence of being denied abortion will likely increase, disproportionately affecting young and poor women.
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Affiliation(s)
- Ushma D Upadhyay
- Ushma D. Upadhyay, Tracy A. Weitz, Rana E. Barar, and Diana Greene Foster are with Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, and the Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco. Rachel K. Jones is with the Guttmacher Institute, New York, NY
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Chasen ST, Kalish RB. Can early ultrasound reduce the gestational age at abortion for fetal anomalies? Contraception 2013; 87:63-6. [DOI: 10.1016/j.contraception.2012.09.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 09/12/2012] [Accepted: 09/12/2012] [Indexed: 11/27/2022]
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Medoff MH, Dennis C. TRAP abortion laws and partisan political party control of state government. AMERICAN JOURNAL OF ECONOMICS AND SOCIOLOGY 2011; 70:951-973. [PMID: 22141177 DOI: 10.1111/j.1536-7150.2011.00794.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Targeted Regulation of Abortion Providers (or TRAP) laws impose medically unnecessary and burdensome regulations solely on abortion providers in order to make abortion services more expensive and difficult to obtain. Using event history analysis, this article examines the determinants of the enactment of a TRAP law by states over the period 1974–2008. The empirical results find that Republican institutional control of a state's legislative/executive branches is positively associated with a state enacting a TRAP law, while Democratic institutional control is negatively associated with a state enacting a TRAP law. The percentage of a state's population that is Catholic, public anti-abortion attitudes, state political ideology, and the abortion rate in a state are statistically insignificant predictors of a state enacting a TRAP law. The empirical results are consistent with the hypothesis that abortion is a redistributive issue and not a morality issue.
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What physicians need to know about the legal status of abortion in the United States. Clin Obstet Gynecol 2009; 52:130-9. [PMID: 19407519 DOI: 10.1097/grf.0b013e3181a2afef] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Abortion is the most politically contested social issue in the United States, a debate that manifests itself in extensive regulation of abortion as a health care service. This study provides a brief history of the judicial acceptance of abortion regulation and an overview of the most common forms of abortion regulation affecting physicians in the United States. The article concludes with a discussion of pending threats to the legal right to abortion in the United States and recommended resources where physicians can find assistance to comply with existing laws.
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