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Whitfield B, Sierra G, Lerma K, Goyal V, Thaxton L, Kumar B, Gilbert A, White K. Abortion Return Rates and Wait Times Before and After Texas' Executive Order Banning Abortion During COVID-19. Am J Public Health 2024; 114:1013-1023. [PMID: 39146519 PMCID: PMC11375354 DOI: 10.2105/ajph.2024.307747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
Objectives. To assess the associations between the executive order that Texas governor Greg Abbott issued on March 22, 2020, postponing procedures deemed not immediately medically necessary, and patients' access to abortion care in Texas. Methods. We used 17 515 individual-level patient records from 13 Texas abortion facilities for matched periods in 2019 and 2020 to examine differences in return rates for abortion after completion of a state-mandated ultrasound and median wait times between ultrasound and abortion visits for those who returned. Results. Patients were less likely to return for an abortion if they had an ultrasound while the executive order was under effect (82.8%) than in the same period in 2019 (90.4%; adjusted odds ratio = 2.06; 95% confidence interval = 1.12, 3.81). Compared with patients at or before 10.0 weeks' gestation at ultrasound, patients at more than 10 weeks' gestation had higher odds of not returning for an abortion or, if they returned, experienced greater wait times between ultrasound and abortion visits. Conclusions. Texas' executive order prohibiting abortion during the COVID-19 pandemic disrupted patients' access to care and disproportionately affected patients who were past 10 weeks' gestation. (Am J Public Health. 2024;114(10):1013-1023. https://doi.org/10.2105/AJPH.2024.307747).
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Affiliation(s)
- Brooke Whitfield
- Brooke Whitfield, Gracia Sierra, Klaira Lerma, Vinita Goyal, and Kari White are with the Population Research Center, University of Texas at Austin. Lauren Thaxton is with Dell Medical School, University of Texas at Austin. Bhavik Kumar is with Planned Parenthood Gulf Coast, Houston, TX. Allison Gilbert is with Southwestern Women's Surgery Center, Dallas, TX
| | - Gracia Sierra
- Brooke Whitfield, Gracia Sierra, Klaira Lerma, Vinita Goyal, and Kari White are with the Population Research Center, University of Texas at Austin. Lauren Thaxton is with Dell Medical School, University of Texas at Austin. Bhavik Kumar is with Planned Parenthood Gulf Coast, Houston, TX. Allison Gilbert is with Southwestern Women's Surgery Center, Dallas, TX
| | - Klaira Lerma
- Brooke Whitfield, Gracia Sierra, Klaira Lerma, Vinita Goyal, and Kari White are with the Population Research Center, University of Texas at Austin. Lauren Thaxton is with Dell Medical School, University of Texas at Austin. Bhavik Kumar is with Planned Parenthood Gulf Coast, Houston, TX. Allison Gilbert is with Southwestern Women's Surgery Center, Dallas, TX
| | - Vinita Goyal
- Brooke Whitfield, Gracia Sierra, Klaira Lerma, Vinita Goyal, and Kari White are with the Population Research Center, University of Texas at Austin. Lauren Thaxton is with Dell Medical School, University of Texas at Austin. Bhavik Kumar is with Planned Parenthood Gulf Coast, Houston, TX. Allison Gilbert is with Southwestern Women's Surgery Center, Dallas, TX
| | - Lauren Thaxton
- Brooke Whitfield, Gracia Sierra, Klaira Lerma, Vinita Goyal, and Kari White are with the Population Research Center, University of Texas at Austin. Lauren Thaxton is with Dell Medical School, University of Texas at Austin. Bhavik Kumar is with Planned Parenthood Gulf Coast, Houston, TX. Allison Gilbert is with Southwestern Women's Surgery Center, Dallas, TX
| | - Bhavik Kumar
- Brooke Whitfield, Gracia Sierra, Klaira Lerma, Vinita Goyal, and Kari White are with the Population Research Center, University of Texas at Austin. Lauren Thaxton is with Dell Medical School, University of Texas at Austin. Bhavik Kumar is with Planned Parenthood Gulf Coast, Houston, TX. Allison Gilbert is with Southwestern Women's Surgery Center, Dallas, TX
| | - Allison Gilbert
- Brooke Whitfield, Gracia Sierra, Klaira Lerma, Vinita Goyal, and Kari White are with the Population Research Center, University of Texas at Austin. Lauren Thaxton is with Dell Medical School, University of Texas at Austin. Bhavik Kumar is with Planned Parenthood Gulf Coast, Houston, TX. Allison Gilbert is with Southwestern Women's Surgery Center, Dallas, TX
| | - Kari White
- Brooke Whitfield, Gracia Sierra, Klaira Lerma, Vinita Goyal, and Kari White are with the Population Research Center, University of Texas at Austin. Lauren Thaxton is with Dell Medical School, University of Texas at Austin. Bhavik Kumar is with Planned Parenthood Gulf Coast, Houston, TX. Allison Gilbert is with Southwestern Women's Surgery Center, Dallas, TX
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Wallace ME, Vilda D, Dyer L, Johnson I, Funke L. Health care use and health consequences of geographic lack of access to abortion and maternity care. Birth 2024; 51:363-372. [PMID: 37968858 PMCID: PMC11093883 DOI: 10.1111/birt.12792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 08/05/2023] [Accepted: 10/12/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND Recent years have brought substantial declines in geographic access to abortion facilities and maternity care across the US. The purpose of this study was to identify the reproductive health consequences of living in a county without access to comprehensive reproductive health care services. METHODS We analyzed National Center for Health Statistics data on all live births occurring in the US in 2020. We used data on locations of abortion facilities and availability of maternity care in order to classify counties by level of access to comprehensive reproductive health care services and defined comprehensive reproductive health care deserts as counties that did not have an abortion facility in the county or in any neighboring county and did not have any maternity care practitioners. We fit modified Poisson regression models with generalized estimating equations to estimate the degree to which living in a comprehensive reproductive health care desert was associated with receipt of timely and adequate prenatal care and risk of preterm birth, controlling for individual-level and county-level characteristics. RESULTS In 2020, one third of counties in the US were comprehensive reproductive health care deserts (n = 1082), and 136,272 births occurred in these counties. In adjusted models, there was no difference in prenatal health care use (timeliness or adequacy of care) between persons in comprehensive reproductive health care deserts and those with full access to care, but the risk of preterm birth was significantly elevated (aRR =1.09, 95% CI = 1.06, 1.13). CONCLUSIONS Lack of access to comprehensive reproductive health care services may increase the incidence of preterm birth.
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Affiliation(s)
- Maeve E Wallace
- Department of Social, Mary Amelia Center for Women's Health Equity Research, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Dovile Vilda
- Department of Social, Mary Amelia Center for Women's Health Equity Research, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Lauren Dyer
- Department of Social, Mary Amelia Center for Women's Health Equity Research, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Iman Johnson
- Department of Social, Mary Amelia Center for Women's Health Equity Research, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
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Riley T, Fiastro AE, Benson LS, Khattar A, Prager S, Godfrey EM. Abortion Provision and Delays to Care in a Clinic Network in Washington State After Dobbs. JAMA Netw Open 2024; 7:e2413847. [PMID: 38809551 PMCID: PMC11137636 DOI: 10.1001/jamanetworkopen.2024.13847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/24/2024] [Indexed: 05/30/2024] Open
Abstract
Importance The Supreme Court decision Dobbs v Jackson Women's Health Organization (Dobbs) overturned federal protections to abortion care and altered the reproductive health care landscape. Thus far, aggregated state-level data reveal increases in the number of abortions in states where abortion is still legal, but there is limited information on delays to care and changes in the characteristics of people accessing abortion in these states after Dobbs. Objective To examine changes in abortion provision and delays to care after Dobbs. Design, Setting, and Participants Retrospective cohort study of all abortions performed at an independent, high-volume reproductive health care clinic network in Washington state from January 1, 2017, to July 31, 2023. Using an interrupted time series, the study assessed changes in abortion care after Dobbs. Exposure Abortion care obtained after (June 24, 2022, to July 31, 2023) vs before (January 1, 2017, to June 23, 2022) Dobbs. Main Outcome and Measure Primary outcomes included weekly number of abortions and out-of-state patients and weekly average of gestational duration (days) and time to appointment (days). Results Among the 18 379 abortions during the study period, most were procedural (13 192 abortions [72%]) and funded by public insurance (11 412 abortions [62%]). The mean (SD) age of individuals receiving abortion care was 28.5 (6.44) years. Following Dobbs, the number of procedural abortions per week increased by 6.35 (95% CI, 2.83-9.86), but then trended back toward pre-Dobbs levels. The number of out-of-state patients per week increased by 2 (95% CI, 1.1-3.6) and trends remained stable. The average gestational duration per week increased by 6.9 (95% CI, 3.6-10.2) days following Dobbs, primarily due to increased gestations of procedural abortions. The average gestational duration among out-of-state patients did not change following Dobbs, but it did increase by 6 days for in-state patients (5.9; 95% CI, 3.2-8.6 days). There were no significant changes in time to appointment. Conclusions and Relevance These findings provide a detailed picture of changes in abortion provision and delays to care after Dobbs in a state bordering a total ban state. In this study, more people traveled from out of state to receive care and in-state patients sought care a week later in gestation. These findings can inform interventions and policies to improve access for all seeking abortion care.
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Affiliation(s)
- Taylor Riley
- Department of Epidemiology, University of Washington, Seattle
| | - Anna E. Fiastro
- Department of Family Medicine, University of Washington, Seattle
| | - Lyndsey S. Benson
- Department of Obstetrics and Gynecology, University of Washington, Seattle
| | | | - Sarah Prager
- Department of Obstetrics and Gynecology, University of Washington, Seattle
| | - Emily M. Godfrey
- Department of Family Medicine, University of Washington, Seattle
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Pleasants E, Parham L, Karen W, Dolgins E, Upadhyay UD, Marshall C, Prata N. Waiting to start abortion: A qualitative exploration of narratives of waiting shared in a Reddit community for abortion post-Dobbs leak in 2022. Soc Sci Med 2024; 349:116877. [PMID: 38657319 DOI: 10.1016/j.socscimed.2024.116877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 02/22/2024] [Accepted: 04/08/2024] [Indexed: 04/26/2024]
Abstract
With the Dobbs leak introducing uncertainty about access and the Dobbs v. Jackson Women's Health Organization decision in June of 2022 overturning the US constitutional right to abortion, delays in accessing desired abortion care are likely growing longer and more common. Timely research on people's experiences waiting to access abortion care is needed. Using data from an abortion subreddit (r/abortion), we analyzed posts that described waiting after having decided to terminate the pregnancy, either by having an in-clinic appointment or ordering medication(s) online for self-managed abortion. Our analysis explored described 1) wait time length, 2) factors contributing to waiting, and 3) impacts of waiting. We used a hybrid inductive and deductive thematic qualitative coding approach to analyze a month-stratified 10% random sample of posts to the r/abortion community in 2022 surrounding the Dobbs leak and decision (May-December, n = 523 posts). Among posts to r/abortion that described waiting to start an abortion (n = 80), wait times ranged from one day to more than a month. Lack of appointment availability and waiting for mailed medications were commonly described as causing delays in accessing in-clinic abortion care and self-managed abortion, respectively. People shared challenges with pregnancy symptoms and feelings of anxiety, fear, isolation, and uncertainty. Posters also commonly described needing additional support while waiting. Overall, waiting to start an abortion was extremely stressful and isolating., with people often waiting weeks between ordering medication or scheduling an appointment and initiating the abortion process. Experiences of waiting to start an abortion and their impacts are of increasing concern as abortion access is further restricted. Additional targeted information and support are needed to mitigate these challenges. Providing timely access is imperative to quality care and overall abortion experiences.
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Affiliation(s)
- Elizabeth Pleasants
- University of California, Berkeley School of Public Health, USA; Wallace Center for Maternal, Child, and Adolescent Health Research, USA.
| | - Lindsay Parham
- University of California, Berkeley School of Public Health, USA; Wallace Center for Maternal, Child, and Adolescent Health Research, USA
| | - Weidert Karen
- University of California, Berkeley School of Public Health, USA; Bixby Center for Population, Health, and Sustainability, USA
| | - Eliza Dolgins
- University of California, Berkeley School of Public Health, USA; Wallace Center for Maternal, Child, and Adolescent Health Research, USA
| | - Ushma D Upadhyay
- University of California, San Francisco Department of Obstetrics, Gynecology, & Reproductive Sciences, USA.
| | - Cassondra Marshall
- University of California, Berkeley School of Public Health, USA; Wallace Center for Maternal, Child, and Adolescent Health Research, USA.
| | - Ndola Prata
- University of California, Berkeley School of Public Health, USA; Bixby Center for Population, Health, and Sustainability, USA
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Hersey AE, Potter-Rutledge JM, Brown BP. Abortion policies at the bedside: incorporating an ethical framework in the analysis and development of abortion legislation. JOURNAL OF MEDICAL ETHICS 2023; 50:2-5. [PMID: 36585243 DOI: 10.1136/jme-2022-108412] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 12/18/2022] [Indexed: 06/17/2023]
Abstract
About 6% of women in the world live in countries that ban all abortions, and 34% in countries that only allow abortion to preserve maternal life or health. In the USA, over the last decades-even before Dobbs v. Jackson Women's Health Organization overturned the federal right to abortion-various states have sought to restrict abortion access. Often times, this legislation has been advanced based on legislators' personal moral values. At the bedside, in contrast, provision of abortion care should adhere to the normative principles of medical ethics and reproductive justice, centreing patients and their individual reproductive intentions and desires. Abortion regulations, through their influence on patients and providers, may facilitate or impede such ethical care at the bedside. In this paper, we present a framework to model how abortion legislation should fit into the patient-provider relationship and to clarify the dynamics by which legislation may affect healthcare encounters. Our proposed framework serves as a tool to analyse the ethical impact of abortion regulations. We propose a model for assessing abortion policies based not on legislators' or advocates' individual moral claims, but on the shared, normative framework of clinical medical ethics. Through contrasting case studies, we demonstrate how a robust normative ethical framework can recentre patients and their reproductive needs. Our model is one way to account for-and safeguard-patients' diverse viewpoints and needs in the development of abortion policy, and it can serve to ground narratives for advocacy by healthcare workers and their professional organisations.
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Affiliation(s)
- Alicia E Hersey
- Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Women and Infants Hospital of Rhode Island, Providence, Rhode Island, USA
| | | | - Benjamin P Brown
- Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Women and Infants Hospital of Rhode Island, Providence, Rhode Island, USA
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Carroll JJ, Ostrach B, El-Sabawi T. Health Inequities Among People Who Use Drugs in a Post- Dobbs America: The Case for a Syndemic Analysis. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2023; 51:549-553. [PMID: 38088631 PMCID: PMC11262022 DOI: 10.1017/jme.2023.96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Punitive policy responses to substance use and to abortion care constitute direct attacks on personal liberty and bodily autonomy. In this article, we leverage the concept of "syndemics" to anticipate how the already synergistic stigmas against people who use drugs and people who seek abortion services will be further compounded the Dobbs decision.
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Crawford BL, Simmons MK, Turner RC, Lo WJ, Jozkowski KN. Perceptions of abortion access across the United States prior to the Dobbs v. Jackson Women's Health Organization decision: Results from a national survey. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2023; 55:153-164. [PMID: 37475195 DOI: 10.1363/psrh.12238] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
CONTEXT Abortion is common in the United States (US), although access is becoming more difficult for some. In addition to restrictive policies that ban most abortion, limit the number of providers and increase costs, barriers to access also include less supportive cultural climates and stigma related to abortion. Prior to the Dobbs v. Jackson Women's Health decision of the United States Supreme Court, research suggested that people generally believed it was easy to access abortion, but this research did not examine the underlying factors that drive these perceptions. METHODS In 2019, using data from closed and open-ended survey questions, we examined differences in people's assessment of abortion access within the state they reside and factors that influence those perceptions. We recruited English- and Spanish-speaking US adults (N = 2599) from Qualtrics' national panel using quota-based sampling to participate in a web-based survey. We used multinomial logistic regression to examine predictors of access perceptions across demographic characteristics and thematic analysis to analyze open-ended responses. RESULTS Fifty-three percent of participants believed abortion was easy to access in their state. Spanish speakers and participants from legislatively "hostile" states were more likely to perceive access as difficult. Legality-related knowledge and pro-life identity were associated with perceiving abortion access as easy. CONCLUSIONS Prior to Dobbs, participants' interpretation of the ease or difficulty of accessing abortion were subjective. Misconceptions about state abortion laws and the prevalence of providers were common, suggesting a need for more education about abortion laws, policies, and access.
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Affiliation(s)
- Brandon L Crawford
- Department of Applied Health Science, School of Public Health, Indiana University Bloomington, Indiana, USA
| | | | - Ronna C Turner
- College of Education and Health Professions, University of Arkansas, Fayetteville, Arkansas, USA
| | - Wen-Juo Lo
- College of Education and Health Professions, University of Arkansas, Fayetteville, Arkansas, USA
| | - Kristen N Jozkowski
- Department of Applied Health Science, School of Public Health, Indiana University Bloomington, Indiana, USA
- The Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University Bloomington, Indiana, USA
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Fledderjohann J, Patterson S, Owino M. Food Insecurity: A Barrier to Reproductive Justice Globally. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2023; 35:296-311. [PMID: 38595861 PMCID: PMC10903663 DOI: 10.1080/19317611.2023.2201841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 04/04/2023] [Accepted: 04/07/2023] [Indexed: 04/11/2024]
Abstract
Objective: Reproductive Justice identifies three core reproductive rights for all people: (1) the right to not have a child; (2) the right to have a child; and (3) the right to parent children in safe and healthy environments. We aim to illustrate that food insecurity infringes upon on all three of these rights and so is a pressing issue for reproductive justice and for sexual and reproductive health more broadly. Methods: Using a phenomenological approach, we outline potential pathways between food insecurity and reproductive justice. Results: There are numerous potential pathways between food insecurity and reproductive justice, including entry into sexual relationships for material support, links to sexually transmitted infections and infertility, structural violence, prioritization and spending tradeoffs between food and other basic necessities, biological impacts of malnutrition, restricted reproductive choices, population control measures, and social stigma and exclusion. Marginalized people are disproportionately impacted by food insecurity and its consequences, with implications for sexual health and pleasure and for reproductive justice. Conclusions:Meaningful and equitable collaboration between people with lived experience of food insecurity, human rights and reproductive justice activists, and academics is critical to sensitively contextualize this work and mobilize broader social change.
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Affiliation(s)
| | - Sophie Patterson
- Faculty of Health and Medicine, Lancaster University, Bailrigg Campus, Lancaster, UK
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Maureen Owino
- Faculty of Environmental Studies and Urban Health, York University, Toronto, Canada
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Moseson H, Smith MH, Chakraborty P, Gyuras HJ, Foster A, Bessett D, Wilkinson TA, Norris AH. Abortion-Related Laws and Concurrent Patterns in Abortion Incidence in Indiana, 2010-2019. Am J Public Health 2023; 113:429-437. [PMID: 36795983 PMCID: PMC10003501 DOI: 10.2105/ajph.2022.307196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2022] [Indexed: 02/18/2023]
Abstract
Objectives. To analyze abortion incidence in Indiana concurrent with changes in abortion-related laws. Methods. Using publicly available data, we created a timeline of abortion-related laws in Indiana, calculated abortion rates by geography, and described changes in abortion occurrence coincident with changes in abortion-related laws between 2010 and 2019. Results. Between 2010 and 2019, Indiana's legislature passed 14 abortion-restricting laws, and 4 of 10 abortion-providing clinics closed. The Indiana abortion rate decreased from 7.8 abortions per 1000 women aged 15 to 44 years in 2010 to 5.9 in 2019. At all time points, the abortion rate was 58% to 71% of the Midwestern rate and 48% to 55% of the national rate. By 2019, nearly 1 in 3 (29%) Indiana residents who obtained abortion care did so outside the state. Conclusions. Access to abortion in Indiana over the past decade was low, required increases in interstate travel to obtain care, and co-occurred with the passage of numerous abortion restrictions. Public Health Implications. These findings preview unequal abortion access and increases in interstate travel as state-level restrictions and bans go into effect across the country. (Am J Public Health. 2023;113(4):429-437. https://doi.org/10.2105/AJPH.2022.307196).
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Affiliation(s)
- Heidi Moseson
- Heidi Moseson is with Ibis Reproductive Health, Oakland, CA. Mikaela H. Smith, Hillary J. Gyuras, Abigail Foster, and Alison H. Norris are with the Ohio Policy Evaluation Network, Ohio State University, Columbus. Danielle Bessett is with the Ohio Policy Evaluation Network, University of Cincinnati, Cincinnati. Payal Chakraborty is with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA. Tracey A. Wilkinson is with the Indiana University School of Medicine, Indianapolis
| | - Mikaela H Smith
- Heidi Moseson is with Ibis Reproductive Health, Oakland, CA. Mikaela H. Smith, Hillary J. Gyuras, Abigail Foster, and Alison H. Norris are with the Ohio Policy Evaluation Network, Ohio State University, Columbus. Danielle Bessett is with the Ohio Policy Evaluation Network, University of Cincinnati, Cincinnati. Payal Chakraborty is with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA. Tracey A. Wilkinson is with the Indiana University School of Medicine, Indianapolis
| | - Payal Chakraborty
- Heidi Moseson is with Ibis Reproductive Health, Oakland, CA. Mikaela H. Smith, Hillary J. Gyuras, Abigail Foster, and Alison H. Norris are with the Ohio Policy Evaluation Network, Ohio State University, Columbus. Danielle Bessett is with the Ohio Policy Evaluation Network, University of Cincinnati, Cincinnati. Payal Chakraborty is with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA. Tracey A. Wilkinson is with the Indiana University School of Medicine, Indianapolis
| | - Hillary J Gyuras
- Heidi Moseson is with Ibis Reproductive Health, Oakland, CA. Mikaela H. Smith, Hillary J. Gyuras, Abigail Foster, and Alison H. Norris are with the Ohio Policy Evaluation Network, Ohio State University, Columbus. Danielle Bessett is with the Ohio Policy Evaluation Network, University of Cincinnati, Cincinnati. Payal Chakraborty is with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA. Tracey A. Wilkinson is with the Indiana University School of Medicine, Indianapolis
| | - Abigail Foster
- Heidi Moseson is with Ibis Reproductive Health, Oakland, CA. Mikaela H. Smith, Hillary J. Gyuras, Abigail Foster, and Alison H. Norris are with the Ohio Policy Evaluation Network, Ohio State University, Columbus. Danielle Bessett is with the Ohio Policy Evaluation Network, University of Cincinnati, Cincinnati. Payal Chakraborty is with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA. Tracey A. Wilkinson is with the Indiana University School of Medicine, Indianapolis
| | - Danielle Bessett
- Heidi Moseson is with Ibis Reproductive Health, Oakland, CA. Mikaela H. Smith, Hillary J. Gyuras, Abigail Foster, and Alison H. Norris are with the Ohio Policy Evaluation Network, Ohio State University, Columbus. Danielle Bessett is with the Ohio Policy Evaluation Network, University of Cincinnati, Cincinnati. Payal Chakraborty is with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA. Tracey A. Wilkinson is with the Indiana University School of Medicine, Indianapolis
| | - Tracey A Wilkinson
- Heidi Moseson is with Ibis Reproductive Health, Oakland, CA. Mikaela H. Smith, Hillary J. Gyuras, Abigail Foster, and Alison H. Norris are with the Ohio Policy Evaluation Network, Ohio State University, Columbus. Danielle Bessett is with the Ohio Policy Evaluation Network, University of Cincinnati, Cincinnati. Payal Chakraborty is with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA. Tracey A. Wilkinson is with the Indiana University School of Medicine, Indianapolis
| | - Alison H Norris
- Heidi Moseson is with Ibis Reproductive Health, Oakland, CA. Mikaela H. Smith, Hillary J. Gyuras, Abigail Foster, and Alison H. Norris are with the Ohio Policy Evaluation Network, Ohio State University, Columbus. Danielle Bessett is with the Ohio Policy Evaluation Network, University of Cincinnati, Cincinnati. Payal Chakraborty is with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA. Tracey A. Wilkinson is with the Indiana University School of Medicine, Indianapolis
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Redd SK, Mosley EA, Narasimhan S, Newton-Levinson A, AbiSamra R, Cwiak C, Hall KS, Hartwig SA, Pringle J, Rice WS. Estimation of Multiyear Consequences for Abortion Access in Georgia Under a Law Limiting Abortion to Early Pregnancy. JAMA Netw Open 2023; 6:e231598. [PMID: 36877521 PMCID: PMC9989903 DOI: 10.1001/jamanetworkopen.2023.1598] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/18/2023] [Indexed: 03/07/2023] Open
Abstract
Importance Following the US Supreme Court ruling in Dobbs v Jackson Women's Health Organization, Georgia's law limiting abortion to early pregnancy, House Bill 481 (HB481), was allowed to go into effect in July 2022. Objectives To estimate anticipated multiyear effects of HB481, which prohibits abortions after detection of embryonic cardiac activity, on abortion incidence in Georgia, and to examine inequities by race, age, and socioeconomic status. Design, Setting, and Participants This repeated cross-sectional analysis used abortion surveillance data from January 1, 2007, to December 31, 2017, to estimate future effects of HB481 on abortion care in Georgia, with a focus on the 2 most recent years of data (2016 and 2017). Abortion surveillance data were obtained from the 2007-2017 Georgia Department of Public Health's Induced Termination of Pregnancy files. Linear regression was used to estimate trends in abortions provided at less than 6 weeks' gestation and at 6 weeks' gestation or later in Georgia, and χ2 analyses were used to compare group differences by race, age, and educational attainment. Data were analyzed from July 26 to September 22, 2022. Exposures HB481, Georgia's law limiting abortion to early pregnancy. Main Outcome and Measures Weeks' gestation at abortion (<6 vs ≥6 weeks). Results From January 1, 2007, to December 31, 2017, there were 360 972 reported abortions in Georgia, with an annual mean (SD) of 32 816 (1812) abortions. Estimates from 2016 to 2017 suggest that 3854 abortions in Georgia (11.6%) would likely meet eligibility requirements for abortion care under HB481. Fewer abortions obtained by Black patients (1943 [9.6%] vs 1280 [16.2%] for White patients), patients younger than 20 years (261 [9.1%] vs 168 [15.0%] for those 40 years and older), and patients with fewer years of education (392 [9.2%] with less than a high school diploma and 1065 [9.6%] with a high school diploma vs 2395 [13.5%] for those with some college) would likely meet eligibility requirements under HB481. Conclusions and Relevance These findings suggest that Georgia's law limiting abortion to early pregnancy (HB481) would eliminate access to abortion for nearly 90% of patients in Georgia, and disproportionately harm patients who are Black, younger, and in lower socioeconomic status groups.
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Affiliation(s)
- Sara K. Redd
- Center for Reproductive Health Research in the Southeast, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Elizabeth A. Mosley
- Center for Reproductive Health Research in the Southeast, Emory University Rollins School of Public Health, Atlanta, Georgia
- Center for Innovative Research on Gender Health Equity, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Suba Narasimhan
- Center for Reproductive Health Research in the Southeast, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Anna Newton-Levinson
- Center for Reproductive Health Research in the Southeast, Emory University Rollins School of Public Health, Atlanta, Georgia
| | | | - Carrie Cwiak
- Center for Reproductive Health Research in the Southeast, Emory University Rollins School of Public Health, Atlanta, Georgia
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Kelli Stidham Hall
- Center for Reproductive Health Research in the Southeast, Emory University Rollins School of Public Health, Atlanta, Georgia
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York
| | - Sophie A. Hartwig
- Center for Reproductive Health Research in the Southeast, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Johanna Pringle
- Center for Reproductive Health Research in the Southeast, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Whitney S. Rice
- Center for Reproductive Health Research in the Southeast, Emory University Rollins School of Public Health, Atlanta, Georgia
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Bell SO, Berger BO, Sufrin C, Dozier JL, Burke AE. An exploratory study of COVID-19-related changes in abortion service availability and use in Washington, DC, Maryland, and Virginia. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2023; 55:12-22. [PMID: 36751866 DOI: 10.1363/psrh.12220] [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: 05/17/2023]
Abstract
OBJECTIVES This exploratory study aimed to assess COVID-19-related changes in abortion service availability and use in Washington, DC, Maryland, and Virginia. DESIGN Data came from a convenience sample of eight abortion clinics in this region. We implemented a cross-sectional survey and collected retrospective aggregate monthly abortion data overall and by facility type, abortion type, and patient characteristics for March 2019-August 2020. We evaluated changes in the distribution of the total number of patients for March-August in 2019 compared to March-August 2020. We also conducted segmented regression analyses and produced scatter plots of monthly abortion patients overall and by facility type, abortion type, and patient characteristics, with separate fitted regression lines from the segmented regression models for the pre- and during-COVID-19 periods. RESULTS Five clinics reported a reduced number of appointments early in the pandemic while four reported increased call volume. There were declines in the monthly abortion trend at hospital-based clinics at the outset of the pandemic. Monthly number of medication abortions increased from March 2020 through August 2020 compared to pre-COVID-19 trends while instrumentation abortions 11 up to 19 weeks decreased. The share of abortions to Black individuals increased during the early phase of the pandemic, as did the monthly trend in abortions among this group. We also saw changes in payment type, with declines in patients paying out-of-pocket. CONCLUSIONS Results revealed differences in abortion services, numbers, and types during the early stages of the COVID-19 pandemic in Washington, DC, Maryland, and Virginia.
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Affiliation(s)
- Suzanne O Bell
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Blair O Berger
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Carolyn Sufrin
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jessica L Dozier
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Anne E Burke
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Stein RA, Katz A, Chervenak FA. The far-reaching impact of abortion bans: reproductive care and beyond. EUR J CONTRACEP REPR 2023; 28:23-27. [PMID: 36369860 DOI: 10.1080/13625187.2022.2140008] [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: 11/15/2022]
Abstract
On 24 June 2022, the US Supreme Court overturned Roe v. Wade, a 49-year-old precedent that provided federal constitutional protection for abortions up to the point of foetal viability, returning jurisdiction to the individual states. Restrictions that came into effect automatically in several states, and are anticipated in others, will severely limit access to abortions in approximately half of the US. Even though every state allows for exceptions to the abortion bans, in some instances these exceptions can be used to preserve the health of a pregnant patient, while in other instances, only to preserve their life. The vague and confusing nature of the abortion ban exceptions threatens to compromise the standard of care for patients with pregnancy complications that are distinct from abortions, such as nonviable pregnancies, miscarriages, and ectopic pregnancies. Additionally, we envision challenges for the treatment of women with certain autoimmune conditions, pregnant cancer patients, and patients contemplating preimplantation genetic diagnosis as part of assisted reproductive technologies. The abortion ban exceptions will impact and interfere with the medical care of pregnant and non-pregnant patient populations alike and are poised to create a medical and public health crisis unlike any other one from the recent past.
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Affiliation(s)
- Richard A Stein
- Department of Chemical and Biomolecular Engineering, NYU Tandon School of Engineering, Brooklyn, NY, USA
| | - Adi Katz
- Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Department of Obstetrics and Gynecology, Lenox Hill Hospital, New York, NY, USA
| | - Frank A Chervenak
- Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Department of Obstetrics and Gynecology, Lenox Hill Hospital, New York, NY, USA
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13
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Biggs A, Foster DG, Gould H, Kimport K, Ralph L, Roberts S, Rocca C, Sisson G, Upadhyay U, Woodruff K. Commentary: The Turnaway Study: A case of self-correction in science upended by political motivation and unvetted findings. Front Psychol 2022; 13:1003116. [DOI: 10.3389/fpsyg.2022.1003116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 11/22/2022] [Indexed: 12/05/2022] Open
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14
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Abortion as Essential Health Care and the Critical Role Your Practice Can Play in Protecting Abortion Access. Obstet Gynecol 2022; 140:729-737. [PMID: 35947856 PMCID: PMC9575566 DOI: 10.1097/aog.0000000000004949] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 07/21/2022] [Indexed: 02/05/2023]
Abstract
Few obstetrician-gynecologists (ob-gyns) provide abortion care, resulting in abortion being separated from other reproductive health care. This segregation of services disrupts the ob-gyn patient-clinician relationship, generates needless costs, delays access to abortion care, and contributes to stigma. General ob-gyns have both the skills and the knowledge to incorporate abortion into their clinical practices. In this way, they can actively contribute to the protection of abortion access now with the loss of federal protection for abortion under Roe v Wade . For those who live where abortion remains legal, now is the time to start providing abortions and enhancing your abortion-referral process. For all, regardless of state legislation, ob-gyns must be leaders in advocacy by facilitating abortion care-across state lines, using telehealth, or with self-managed abortion-and avoiding any contribution to the criminalization of those who seek or obtain essential abortion care. Our patients deserve a specialty-wide concerted effort to deliver comprehensive reproductive health care to the fullest extent.
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Ehrenreich K, Biggs MA, Grossman D. Making the case for advance provision of mifepristone and misoprostol for abortion in the United States. BMJ SEXUAL & REPRODUCTIVE HEALTH 2022; 48:238-242. [PMID: 34862207 DOI: 10.1136/bmjsrh-2021-201321] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 11/03/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Katherine Ehrenreich
- Advancing New Standards In Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, Oakland, California, USA
| | - M Antonia Biggs
- Advancing New Standards In Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, Oakland, California, USA
| | - Daniel Grossman
- Advancing New Standards In Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, Oakland, California, USA
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Kimport K. Abortion after Dobbs: Defendants, denials, and delays. SCIENCE ADVANCES 2022; 8:eade5327. [PMID: 36070372 PMCID: PMC9451164 DOI: 10.1126/sciadv.ade5327] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 08/22/2022] [Indexed: 06/15/2023]
Abstract
The U.S. Supreme Court's Dobbs decision will lead to more criminalization of activities during pregnancy, more abortion denials, and more abortions after the first trimester.
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Affiliation(s)
- Katrina Kimport
- ANSIRH (Advancing New Standards in Reproductive Health), University of California San Francisco, San Francisco, CA, USA.
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17
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Foster DG, Biggs MA, Ralph L, Gerdts C, Roberts S, Glymour MM. Socioeconomic Outcomes of Women Who Receive and Women Who Are Denied Wanted Abortions in the United States. Am J Public Health 2022; 112:1290-1296. [PMID: 35969820 PMCID: PMC9382171 DOI: 10.2105/ajph.2017.304247r] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Dozier JL, Sufrin C, Berger BO, Burke AE, Bell SO. COVID-19 impacts on abortion care-seeking experiences in the Washington, DC, Maryland, and Virginia regions of the United States. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2022; 54:68-79. [PMID: 35790127 PMCID: PMC9349554 DOI: 10.1363/psrh.12202] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
CONTEXT Many people wanted to avoid or delay childbearing during the COVID-19 pandemic. This study sought to examine the extent COVID-19 influenced abortion care-seeking in a region that did not enact policy restricting abortion due to the pandemic, has high service availability, and few abortion-restrictive policies. METHODOLOGY We conducted telephone surveys with adults (n=72) requesting abortion appointments between September 2020 and March 2021 at five clinics in Washington, DC, Maryland, and Virginia. We used χ2 tests to compare sociodemographic, reproductive history, service delivery characteristics, and pandemic-related life changes by whether COVID-19 influenced abortion care-seeking. RESULTS Most respondents (93%) had an abortion at the time of the survey, 4% were awaiting their scheduled appointment, and 3% did not have an appointment scheduled. Nearly 40% of people reported COVID-19 influenced their decision to have an abortion. These individuals were significantly more likely to report "not financially prepared" (44% vs. 16%) as a reason for termination compared to people reporting no influence of COVID-19. They were also more likely to have lost or changed their health insurance due to pandemic-related employment changes (15% vs. 2%), report substantial money difficulties due to COVID-19 (59% vs. 33%), and report that paying for their abortion was "very difficult" (25% vs. 2%). CONCLUSION COVID-19 influenced many people to have an abortion, particularly those financially disadvantaged by the pandemic. Expansion of Medicaid abortion coverage in Washington, DC and Virginia could reduce financial barriers to care and help people to better meet their reproductive needs amid future crises.
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Affiliation(s)
- Jessica L. Dozier
- Department of Population, Family and Reproductive HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Carolyn Sufrin
- Department of Gynecology and ObstetricsJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Department of Health, Behavior, and SocietyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Blair O. Berger
- Department of Population, Family and Reproductive HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Anne E. Burke
- Department of Population, Family and Reproductive HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Department of Gynecology and ObstetricsJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Suzanne O. Bell
- Department of Population, Family and Reproductive HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
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19
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Mosley EA, Ayala S, Jah Z, Hailstorks T, Dixon Diallo D, Hernandez N, Jackson K, Hairston I, Hall KS. Community-led research for reproductive justice: Exploring the SisterLove Georgia Medication Abortion project. Front Glob Womens Health 2022; 3:969182. [PMID: 36033920 PMCID: PMC9412101 DOI: 10.3389/fgwh.2022.969182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 07/26/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction While reproductive injustice indicators are improving globally, they are worsening in the United States particularly for Black and other marginalized communities. Eugenics and obstetric violence against low-income and communities of color create well-founded distrust of sexual and reproductive health (SRH). Transformational, reparative ways of conducting SRH research are needed. Proposed principles of community-led research for reproductive justice Drawing on our collective experience as reproductive justice leaders, SRH researchers, and clinicians, we propose the following principles of community-led research for reproductive justice: 1) Center the marginalized community members most affected by SRH inequities as leaders of research; 2) Facilitate equitable, collaborative partnership through all phases of SRH research; 3) Honor multiple ways of knowing (experiential, cultural, empirical) for knowledge justice and cross-directional learning across the team; 4) Build on strengths (not deficits) within the community; 5) Implement the tenets of reproductive justice including structural-level analysis and the human rights framework; 6) Prioritize disseminating useful findings to community members first then to other audiences; 7) Take action to address social and reproductive injustices. SisterLove's community-led georgia medication abortion project We offer the community-led Georgia Medication Abortion (GAMA) Project by reproductive justice organization SisterLove from 2018-2022 as a case study to demonstrate these principles along with the strengths and challenges of reproductive justice research. Discussion Community-led reproductive justice research offers innovative and transformational methods for truly advancing SRH in an era of increasing policy restrictions and decreasing access to care. Yet existing funding, research administrative, and publishing systems will require structural change.
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Affiliation(s)
- Elizabeth A. Mosley
- Center for Reproductive Health Research in the Southeast (RISE), Emory University School of Public Health, Atlanta, GA, United States
| | | | - Zainab Jah
- SisterLove, Inc., Atlanta, GA, United States
- National Birth Equity Collaborative, Washington, DC, United States
| | - Tiffany Hailstorks
- Center for Reproductive Health Research in the Southeast (RISE), Emory University School of Public Health, Atlanta, GA, United States
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, United States
| | | | - Natalie Hernandez
- Center for Maternal Health Equity, Morehouse School of Medicine, Atlanta, GA, United States
| | | | | | - Kelli S. Hall
- Center for Reproductive Health Research in the Southeast (RISE), Emory University School of Public Health, Atlanta, GA, United States
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY, United States
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20
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Baca M, Harrison ME, Grubb L, Hoopes A, Hwang L, Maslowsky J, Romano M, Tebb K, Tyson N. SAHM/NASPAG Statement on Leaked Draft SCOTUS Opinion Regarding Mississippi v Jackson Women's Health. J Pediatr Adolesc Gynecol 2022; 35:417-419. [PMID: 35618232 DOI: 10.1016/j.jpag.2022.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Melanie Baca
- Children's Hospital of Eastern Ontario, Pediatrics, 401 Smyth Rd, Ottawa, ON, Canada K1H8L1, Phone: 613 737 7600
| | - Megan E Harrison
- Children's Hospital of Eastern Ontario, Pediatrics, 401 Smyth Rd, Ottawa, ON, Canada K1H8L1, Phone: 613 737 7600.
| | - Laura Grubb
- Children's Hospital of Eastern Ontario, Pediatrics, 401 Smyth Rd, Ottawa, ON, Canada K1H8L1, Phone: 613 737 7600
| | - Andrea Hoopes
- Children's Hospital of Eastern Ontario, Pediatrics, 401 Smyth Rd, Ottawa, ON, Canada K1H8L1, Phone: 613 737 7600
| | - Loris Hwang
- Children's Hospital of Eastern Ontario, Pediatrics, 401 Smyth Rd, Ottawa, ON, Canada K1H8L1, Phone: 613 737 7600
| | - Julie Maslowsky
- Children's Hospital of Eastern Ontario, Pediatrics, 401 Smyth Rd, Ottawa, ON, Canada K1H8L1, Phone: 613 737 7600
| | - Mary Romano
- Children's Hospital of Eastern Ontario, Pediatrics, 401 Smyth Rd, Ottawa, ON, Canada K1H8L1, Phone: 613 737 7600
| | - Kathleen Tebb
- Children's Hospital of Eastern Ontario, Pediatrics, 401 Smyth Rd, Ottawa, ON, Canada K1H8L1, Phone: 613 737 7600
| | - Nichole Tyson
- Children's Hospital of Eastern Ontario, Pediatrics, 401 Smyth Rd, Ottawa, ON, Canada K1H8L1, Phone: 613 737 7600
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Seymour JW, Thompson TA, Milechin D, Wise LA, Rudolph AE. Potential Impact of Telemedicine for Medication Abortion Policy and Programming Changes on Abortion Accessibility in the United States. Am J Public Health 2022; 112:1202-1211. [PMID: 35830676 PMCID: PMC9342822 DOI: 10.2105/ajph.2022.306876] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2022] [Indexed: 11/04/2022]
Abstract
Objectives. To quantify the impact of telemedicine for medication abortion (TMAB) expansion or ban removal on abortion accessibility. Methods. We included 1091 facilities from the 2018 Advancing New Standards in Reproductive Health facility database and Planned Parenthood Web site, among which 241 did not offer abortion as sites for TMAB expansion. Accessibility was defined as the proportion of reproductive-aged women living within a 30-, 60-, or 90-minute drive time from an abortion-providing facility. We calculated accessibility differences between 3 scenarios: (1) facilities offering abortion in 2018 (reference), (2) the reference scenario in addition to all facilities in states without TMAB bans (TMAB expansion), and (3) all facilities (TMAB ban removal). We also stratified by state and urban-rural status. Results. In 2018, 65%, 81%, and 89% of women lived within a 30-, 60-, or 90-minute drive time from an abortion-providing facility, respectively. Expansion and ban removal expanded abortion accessibility relative to the current accessibility scenario (range: 1.25-5.66 percentage points). Women in rural blocks experienced greater increases in accessibility than those in urban blocks. Conclusions. TMAB program and policy changes could expand abortion accessibility to an additional 3.5 million reproductive-aged women. Public Health Implications. Our findings can inform where to invest resources to improve abortion accessibility. (Am J Public Health. 2022;112(8):1202-1211. https://doi.org/10.2105/AJPH.2022.306876).
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Affiliation(s)
- Jane W Seymour
- Jane W. Seymour is with the Department of Epidemiology, School of Public Health, Boston University, Boston, MA, and Ibis Reproductive Health, Cambridge, MA. Terri-Ann Thompson is with Ibis Reproductive Health. Dennis Milechin is with Research Computing Services, Information Services and Technology, Boston University. Lauren A. Wise is with the Department of Epidemiology, School of Public Health, Boston University. Abby E. Rudolph is with the Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, PA
| | - Terri-Ann Thompson
- Jane W. Seymour is with the Department of Epidemiology, School of Public Health, Boston University, Boston, MA, and Ibis Reproductive Health, Cambridge, MA. Terri-Ann Thompson is with Ibis Reproductive Health. Dennis Milechin is with Research Computing Services, Information Services and Technology, Boston University. Lauren A. Wise is with the Department of Epidemiology, School of Public Health, Boston University. Abby E. Rudolph is with the Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, PA
| | - Dennis Milechin
- Jane W. Seymour is with the Department of Epidemiology, School of Public Health, Boston University, Boston, MA, and Ibis Reproductive Health, Cambridge, MA. Terri-Ann Thompson is with Ibis Reproductive Health. Dennis Milechin is with Research Computing Services, Information Services and Technology, Boston University. Lauren A. Wise is with the Department of Epidemiology, School of Public Health, Boston University. Abby E. Rudolph is with the Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, PA
| | - Lauren A Wise
- Jane W. Seymour is with the Department of Epidemiology, School of Public Health, Boston University, Boston, MA, and Ibis Reproductive Health, Cambridge, MA. Terri-Ann Thompson is with Ibis Reproductive Health. Dennis Milechin is with Research Computing Services, Information Services and Technology, Boston University. Lauren A. Wise is with the Department of Epidemiology, School of Public Health, Boston University. Abby E. Rudolph is with the Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, PA
| | - Abby E Rudolph
- Jane W. Seymour is with the Department of Epidemiology, School of Public Health, Boston University, Boston, MA, and Ibis Reproductive Health, Cambridge, MA. Terri-Ann Thompson is with Ibis Reproductive Health. Dennis Milechin is with Research Computing Services, Information Services and Technology, Boston University. Lauren A. Wise is with the Department of Epidemiology, School of Public Health, Boston University. Abby E. Rudolph is with the Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, PA
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22
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Kimport K. Is third-trimester abortion exceptional? Two pathways to abortion after 24 weeks of pregnancy in the United States. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2022; 54:38-45. [PMID: 35403366 PMCID: PMC9321603 DOI: 10.1363/psrh.12190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/21/2022] [Accepted: 03/24/2022] [Indexed: 06/14/2023]
Abstract
CONTEXT In the United States, third-trimester abortions are substantially more expensive, difficult to obtain, and stigmatized than first-trimester abortions. However, the circumstances that lead to someone needing a third-trimester abortion may have overlaps with the pathways to abortion at other gestations. METHODS I interviewed 28 cisgender women who obtained an abortion after the 24th week of pregnancy using a modified timeline interview method. I coded the interviews thematically, focusing on characterizing the experience of deciding to obtain a third-trimester abortion. RESULTS I find two pathways to needing a third-trimester abortion: new information, wherein the respondent learned new information about the pregnancy-such as of an observed serious fetal health issue or that she was pregnant-that made the pregnancy not (or no longer) one she wanted to continue; and barriers to abortion, wherein the respondent was in the third trimester by the time she was able to surmount the obstacles to abortion she faced, including cost, finding a provider, and stigmatization. These two pathways were not wholly distinct and sometimes overlapped. CONCLUSIONS The inherent limits of medical knowledge and the infeasibility of ensuring early pregnancy recognition in all cases illustrate the impossibility of eliminating the need for third-trimester abortion. The similarities between respondents' experiences and that of people seeking abortion at other gestations, particularly regarding the impact of barriers to abortion, point to the value of a social conceptualization of need for abortion that eschews a trimester or gestation-based framework and instead conceptualizes abortion as an option throughout pregnancy.
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Affiliation(s)
- Katrina Kimport
- Advancing New Standards in Reproductive Health (ANSIRH)University of California San FranciscoOaklandCaliforniaUSA
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23
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Pleasants EA, Cartwright AF, Upadhyay UD. Association Between Distance to an Abortion Facility and Abortion or Pregnancy Outcome Among a Prospective Cohort of People Seeking Abortion Online. JAMA Netw Open 2022; 5:e2212065. [PMID: 35560050 PMCID: PMC9107030 DOI: 10.1001/jamanetworkopen.2022.12065] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Many people face barriers to abortion care, including long distances to an abortion facility. OBJECTIVES To investigate the association of distance to the nearest abortion facility with abortion or pregnancy outcome. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted using data from the Google Ads Abortion Access study, a prospective cohort study of individuals considering abortion recruited between August 2017 and May 2018. Individuals from 50 states and Washington, District of Columbia, who were pregnant and considering abortion based on self-report were recruited online using a stratified sampling technique. Participants completed online baseline and 4-week follow-up surveys. Data were analyzed between May and August 2021. EXPOSURES Driving distance to an abortion facility calculated from participant zip code and grouped into 4 categories (<5 miles, 5-24 miles, 25-49 miles, and ≥50 miles). MAIN OUTCOMES AND MEASURES Abortion or pregnancy outcome reported at 4-week follow-up, categorized as had an abortion, still seeking an abortion, or planning to continue pregnancy. Other measures included reported experience of 8 distance-related barriers to abortion, such as having to gather money for travel expenses and having to keep the abortion a secret. RESULTS Among 1485 pregnant individuals considering abortion who completed the baseline survey and provided contact information, 1005 individuals completed follow-up (follow-up rate, 67.7%) and 856 participants were included in the analytic sample (443 individuals ages 25-34 years [51.8%]; 208 Black individuals [24.3%]; 101 Hispanic or Latinx individuals [11.8%], and 468 White individuals [54.8%]). Most participants had at least some college education (474 individuals [55.5%]). Distance to an abortion facility was less than 5 miles for 233 individuals (27.2%), 5 to 24 miles for 373 individuals (43.6%), 25 to 49 miles for 85 individuals (9.9%), and 50 or more miles for 165 individuals (19.3%) (mean [SD] distance = 28.3 [43.8] miles). Most participants reported at least 1 distance-related barrier (763 individuals [89.1%]), with a mean of 3.3 barriers (95% CI, 3.2-3.5 barriers) reported. For 7 of 8 distance-related barriers, an increased percentage of participants living farther from an abortion facility reported the barrier compared with participants living less than 5 miles from a facility; for example, 61.8% (95% CI, 53.5%-69.4%) of individuals living less than 5 miles reported having to gather money for travel expenses, while 81.2% (95% CI, 70.8%-88.5%; P = .002) of those living 25 to 49 miles and 75.8% (95% CI, 69.9%-81.0%; P = .02) of those living 50 or more miles from a facility reported this barrier. At follow-up, participants living 50 or more miles from a facility had higher odds of still being pregnant and seeking abortion (adjusted odds ratio [aOR] = 2.07; 95% CI, 1.35-3.17; P = .001) or planning to continue pregnancy (aOR = 1.96; 95% CI, 1.06-3.63; P = .03) compared with participants living within 5 miles. CONCLUSIONS AND RELEVANCE This study found that greater distance from an abortion facility was associated with delays in obtaining abortion care and inability to receive abortion care. These findings suggest that innovative approaches to abortion provision may be needed to mitigate outcomes associated with long distances to abortion facilities.
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Affiliation(s)
| | - Alice F. Cartwright
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
- Carolina Population Center, University of North Carolina at Chapel Hill
| | - Ushma D. Upadhyay
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland
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Moseson H, Seymour JW, Zuniga C, Wollum A, Katz A, Thompson TA, Gerdts C. "It just seemed like a perfect storm": A multi-methods feasibility study on the use of Facebook, Google Ads, and Reddit to collect data on abortion-seeking experiences from people who considered but did not obtain abortion care in the United States. PLoS One 2022; 17:e0264748. [PMID: 35239738 PMCID: PMC8893629 DOI: 10.1371/journal.pone.0264748] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/14/2022] [Indexed: 12/03/2022] Open
Abstract
Most studies of abortion access have recruited participants from abortion clinics, thereby missing people for whom barriers to care were insurmountable. Consequently, research may underestimate the nature and scope of barriers that exist. We aimed to recruit participants who had considered, but failed to obtain, an abortion using three online platforms, and to evaluate the feasibility of collecting data on their abortion-seeking experiences in a multi-modal online study. In 2018, we recruited participants for this feasibility study from Facebook, Google Ads, and Reddit for an online survey about experiences seeking abortion care in the United States; we additionally conducted in-depth interviews among a subset of survey participants. We completed descriptive analyses of survey data, and thematic analyses of interview data. Recruitment results have been previously published. For the primary outcomes of this analysis, over one month, we succeeded in capturing data on abortion-seeking experiences from 66 individuals who were not currently pregnant and reported not having obtained an abortion, nor visited an abortion facility, despite feeling that abortion could have been the best option for a recent pregnancy. A subset of survey respondents (n = 14) completed in-depth interviews. Results highlighted multiple, reinforcing barriers to abortion care, including legal restrictions such as gestational limits and waiting periods that exacerbated financial and other burdens, logistical and informational barriers, as well as barriers to abortion care less frequently reported in the literature, such as a preference for medication abortion. These findings support the use of online recruitment to identify and survey an understudied population about their abortion-seeking experiences. Further, findings contribute to a more complete understanding of the full range of barriers to abortion care that people experience in the United States, and how these barriers intersect to not just delay, but to prevent people from obtaining abortion.
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Affiliation(s)
- Heidi Moseson
- Ibis Reproductive Health, Oakland, California, United States of America
- * E-mail:
| | - Jane W. Seymour
- Ibis Reproductive Health, Cambridge, Massachusetts, United States of America
| | - Carmela Zuniga
- Ibis Reproductive Health, Cambridge, Massachusetts, United States of America
| | - Alexandra Wollum
- Ibis Reproductive Health, Oakland, California, United States of America
| | - Anna Katz
- Ibis Reproductive Health, Oakland, California, United States of America
| | - Terri-Ann Thompson
- Ibis Reproductive Health, Cambridge, Massachusetts, United States of America
| | - Caitlin Gerdts
- Ibis Reproductive Health, Oakland, California, United States of America
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Upadhyay UD, Ahlbach C, Kaller S, Cook C, Muñoz I. Trends In Self-Pay Charges And Insurance Acceptance For Abortion In The United States, 2017-20. Health Aff (Millwood) 2022; 41:507-515. [PMID: 35377750 DOI: 10.1377/hlthaff.2021.01528] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Hyde Amendment prevents federal funds, including Medicaid, from covering abortion care, and many states have legal restrictions that prevent private insurance plans from covering abortion. As a result, most people pay for abortion out of pocket. We examined patient self-pay charges for three abortion types (medication abortion, first-trimester procedural abortion, and second-trimester abortion), as well as facilities' acceptance of health insurance, during the period 2017-20. We found that during this time, median patient charges increased for medication abortion (from $495 to $560) and first-trimester procedural abortion (from $475 to $575) but not second-trimester abortion (from $935 to $895). The proportion of facilities that accept insurance decreased over time (from 89 percent to 80 percent). We noted substantial regional variation, with the South having lower costs and lower insurance acceptance. Charges for first-trimester procedural abortions are increasing, and acceptance of health insurance is declining. According to the Federal Reserve, one-quarter of Americans could not pay for a $400 emergency expense solely with the money in their bank accounts-an amount lower than any abortion cost in 2020. Lifting Hyde restrictions and requiring public and private health insurance to cover this essential, time-sensitive health service without copays or deductibles would greatly reduce the financial burden of abortion.
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Affiliation(s)
- Ushma D Upadhyay
- Ushma D. Upadhyay , University of California San Francisco (UCSF), San Francisco, California
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Zuniga C, Bommaraju A, Hasselbacher L, Stulberg D, Thompson TA. Provider and community stakeholder perspectives of expanding Medicaid coverage of abortion in Illinois. BMC Health Serv Res 2022; 22:413. [PMID: 35351132 PMCID: PMC8960679 DOI: 10.1186/s12913-022-07761-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 03/10/2022] [Indexed: 11/29/2022] Open
Abstract
Background Many people seeking abortion encounter financial difficulties that delay or prevent them from accessing care. Although some patients qualify for Medicaid (a public program that can help cover health care costs), laws in some states restrict the use of Medicaid for abortion care. In 2017, Illinois passed House Bill 40 (HB-40), which allowed patients with Medicaid to receive coverage for their abortion. This study aimed to understand how HB-40 affected abortion affordability from the perspectives of individuals that work directly or indirectly with abortion patients or facilities providing abortion care. Methods We conducted interviews with clinicians and administrators from facilities that provided abortion services; staff from organizations that provided resources to abortion providers or patients; and individuals at organizations involved in the passage and/or implementation of HB-40. Interviews were audio-recorded and transcribed. We created codes based on the interview guides, coded each transcript using the web application Dedoose, and summarized findings by code. Results Interviews were conducted with 38 participants. Participants reflected that HB-40 seemed to remove a significant financial barrier for Medicaid recipients and improve the experience for patients seeking abortion care. Participants also described how the law led to a shift in resource allocation, allowing financial support to be directed towards uninsured patients. Some participants thought HB-40 might contribute to a reduction in abortion stigma. Despite the perceived positive impacts of the law, participants noted a lack of public knowledge about HB-40, as well as confusing or cumbersome insurance-related processes, could diminish the law’s impact. Participants also highlighted persisting barriers to abortion utilization for minors, recent and undocumented immigrants, and people residing in rural areas, even after the passage of HB-40. Conclusions HB-40 was perceived to improve the affordability of abortion. However, participants identified additional obstacles to abortion care in Illinois that weakened the impact of HB-40 for patients and required further action, Findings suggest that policymakers must also consider how insurance coverage can be disrupted by other legal barriers for historically excluded populations and ensure clear information on Medicaid enrollment and abortion coverage is widely disseminated. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07761-5.
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Smith MH, Muzyczka Z, Chakraborty P, Johns-Wolfe E, Higgins J, Bessett D, Norris AH. Abortion travel within the United States: An observational study of cross-state movement to obtain abortion care in 2017. LANCET REGIONAL HEALTH. AMERICAS 2022; 10:100214. [PMID: 36777689 PMCID: PMC9903901 DOI: 10.1016/j.lana.2022.100214] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background In the United States, abortion access is often more limited for people who live in states with few abortion facilities and restrictive abortion legislation. Pregnant people seeking an abortion thus often travel to access care. Methods We calculated state-specific abortion rate (number of abortions per thousand women ages 15 to 44) and percentage of patients leaving for abortion care using CDC 2017 Abortion Surveillance data, the Guttmacher Institute's Abortion Provider Census and Pregnancies, Births and Abortions in the United States report, and US Census data. We categorized percent leaving by abortion policy landscape using the Guttmacher Institute's classification of state abortion laws, and by facility density (number of abortion facilities per million women ages 15 to 44), calculated using Census and Guttmacher data. We ran correlational tests between each of our variables (percent leaving, facility density, and policy environment), as well as between percent leaving and facility density within policy environment. Findings In 2017, an average of 8% of US patients left their state of residence for abortion care. Percent leaving varied widely by state: 74% left Wyoming, 57% left South Carolina, and 56% left Missouri, while 13 states had fewer than 4% of patients leaving. States with more restrictive laws averaged 12% of patients leaving, while states with middle ground or supportive laws averaged 10% and 3% leaving, respectively. Pairwise correlations between percent leaving, facility density, and policy score were all statistically significant, though correlations between percent leaving and facility density within policy environment were not. Interpretation Many patients travel across state lines for abortion care. While patients may leave for a range of reasons, restrictive state-level abortion policy and facility scarcity are associated with patients leaving their state of residence. Funding This study was supported by a philanthropic foundation that makes grants anonymously.
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Affiliation(s)
- Mikaela H. Smith
- Division of Epidemiology, College of Public Health, Ohio State University, 60 Townshend Hall, 1885 Neil Ave. Mall, Columbus, OH 43212, United States,Corresponding author.
| | - Zoe Muzyczka
- Department of Sociology, University of Cincinnati, OH, United States
| | - Payal Chakraborty
- Division of Epidemiology, College of Public Health, Ohio State University, 60 Townshend Hall, 1885 Neil Ave. Mall, Columbus, OH 43212, United States
| | - Elaina Johns-Wolfe
- Department of Sociology, University of Missouri St. Louis, MO, United States
| | - Jenny Higgins
- Department of Gender and Women's Studies and Obstetrics and Gynecology, University of Wisconsin-Madison, United States
| | - Danielle Bessett
- Department of Sociology, University of Cincinnati, OH, United States
| | - Alison H. Norris
- Division of Epidemiology, College of Public Health, Ohio State University, 60 Townshend Hall, 1885 Neil Ave. Mall, Columbus, OH 43212, United States
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Toscano M, Wood J, Spielman S, Ferri R, Whaley N, Seligman NS. Prenatal care utilization in pregnant women who consider but do not have abortions. BMC Pregnancy Childbirth 2022; 22:53. [PMID: 35062913 PMCID: PMC8780296 DOI: 10.1186/s12884-021-04343-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 12/16/2021] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Over half of all pregnancies in the United States are unintended, and 18% result in termination of pregnancy (TOP). Some women seek TOP, but ultimately continue their pregnancy. Data are limited about their utilization of prenatal care and their perinatal outcomes. Our primary outcome was to investigate differences in guideline-based prenatal care utilization in women who consider but do not have an abortion.
Methods
Retrospective cohort study of patients having obstetrical dating ultrasound (US) from 2011–2018 at a single academic medical center that offers TOP. Contemplators completed US with intention of TOP but instead continued the pregnancy to live birth. A 2:1 group of non-contemplators completed US and continued to live birth. A prenatal care utilization scoring system was used to compare groups. Secondary outcomes investigated differences in adverse pregnancy outcomes and postpartum care.
Results
There were 94 contemplators and 183 non-contemplators. Inadequate prenatal care utilization initially was more common in contemplators than non-contemplators (62.8% vs 85.8%, p < 0.01) but was not significant after adjustment (aOR 1.0, 95% CI 0.40 – 2.56). There were no differences in adverse obstetric or neonatal outcomes. Contemplators were significantly more likely to have a postpartum contraceptive method (PPCM) upon hospital discharge (aOR 4.8, 95% CI 1.16 – 20.0) and significantly more likely to use a highly-effective PPCM (aOR 6.4, 95% CI 2.34 – 17.4).
Conclusions
Reversal of intention for TOP is not associated with differences in prenatal care utilization, but is associated with increased uptake of postpartum contraceptive method.
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Leyser-Whalen O, Torres L, Gonzales B. Revealing Economic and Racial Injustices: Demographics of Abortion Fund Callers on the U.S.-Mexico Border. WOMEN'S REPRODUCTIVE HEALTH (PHILADELPHIA, PA.) 2022; 8:188-202. [PMID: 35005056 DOI: 10.1080/23293691.2021.1973845] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
There are multiple accessibility challenges to abortion care in the United States. Most abortion research relies on clinic data, whereas we utilized data from an abortion fund on the U.S.-Mexico border. The majority of the sample were Latinx (62.2%), were 20-29 years old (59.7%), were in the first trimester (65.4%), and traveled hundreds of miles to an abortion clinic. Younger age, being in the third trimester, not having insurance, and having some resources were associated with likelihood of receiving aid for an abortion procedure. There is still a great need for abortion funding and access, particularly for young, economically disadvantaged people of color.
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Affiliation(s)
- Ophra Leyser-Whalen
- Department of Sociology & Anthropology, University of Texas at El Paso, El Paso, Texas, USA
| | - Luis Torres
- Department of Sociology & Anthropology, University of Texas at El Paso, El Paso, Texas, USA
| | - Brianna Gonzales
- Department of Sociology & Anthropology, University of Texas at El Paso, El Paso, Texas, USA
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Ruggiero SP, Seymour JW, Thompson TA, Kohn JE, Snow JL, Grossman D, Fix L. Patient and provider experiences using a site-to-site telehealth model for medication abortion. Mhealth 2022; 8:32. [PMID: 36338311 PMCID: PMC9634192 DOI: 10.21037/mhealth-22-12] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 08/07/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND In the site-to-site telehealth for medication abortion model, patients visit a health center to meet with a remote clinician using telehealth technology. This model is safe, effective, and acceptable to patients and providers. The objective of this study was to document the experiences of patients and providers using telehealth for medication abortion in Planned Parenthood health centers across different geographical contexts in the United States. METHODS We conducted in-depth interviews with Planned Parenthood medication abortion patients who either met with a clinician at the clinic via telehealth or in-person about their experiences receiving care. We also interviewed Planned Parenthood staff members about their experiences implementing telehealth for medication abortion at their health center. RESULTS We interviewed 29 patients who received care at Planned Parenthood health centers in five states. Both telehealth and in-person patients described positive interactions with health center staff and clinicians. The vast majority of telehealth patients said that they felt comfortable speaking with the clinician over telehealth and had no trouble using the telehealth technology. We interviewed 12 providers, including clinicians and administrative staff, who worked in seven states. Providers largely thought that telehealth for medication abortion expanded access to medication abortion. CONCLUSIONS Across different locations, our findings indicate that patients found telehealth for medication abortion services to be highly acceptable and providers found that telehealth services may help improve medication abortion access. As the use of telehealth for medication abortion expands, future research should include additional measures of quality to ensure that services are acceptable across different identities and experiences, including age, race, gender, and income level.
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Affiliation(s)
| | | | | | - Julia E. Kohn
- Planned Parenthood Federation of America, New York, NY, USA
| | | | - Daniel Grossman
- Advancing New Standards in Reproductive Health, University of California, San Francisco, CA, USA
| | - Laura Fix
- Ibis Reproductive Health, Cambridge, MA, USA
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Moseson H, Fix L, Gerdts C, Ragosta S, Hastings J, Stoeffler A, Goldberg EA, Lunn MR, Flentje A, Capriotti MR, Lubensky ME, Obedin-Maliver J. Abortion attempts without clinical supervision among transgender, nonbinary and gender-expansive people in the United States. BMJ SEXUAL & REPRODUCTIVE HEALTH 2022; 48:e22-e30. [PMID: 33674348 PMCID: PMC8685648 DOI: 10.1136/bmjsrh-2020-200966] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/09/2021] [Accepted: 02/15/2021] [Indexed: 06/01/2023]
Abstract
BACKGROUND Transgender, nonbinary and gender-expansive (TGE) people face barriers to abortion care and may consider abortion without clinical supervision. METHODS In 2019, we recruited participants for an online survey about sexual and reproductive health. Eligible participants were TGE people assigned female or intersex at birth, 18 years and older, from across the United States, and recruited through The PRIDE Study or via online and in-person postings. RESULTS Of 1694 TGE participants, 76 people (36% of those ever pregnant) reported considering trying to end a pregnancy on their own without clinical supervision, and a subset of these (n=40; 19% of those ever pregnant) reported attempting to do so. Methods fell into four broad categories: herbs (n=15, 38%), physical trauma (n=10, 25%), vitamin C (n=8, 20%) and substance use (n=7, 18%). Reasons given for abortion without clinical supervision ranged from perceived efficiency and desire for privacy, to structural issues including a lack of health insurance coverage, legal restrictions, denials of or mistreatment within clinical care, and cost. CONCLUSIONS These data highlight a high proportion of sampled TGE people who have attempted abortion without clinical supervision. This could reflect formidable barriers to facility-based abortion care as well as a strong desire for privacy and autonomy in the abortion process. Efforts are needed to connect TGE people with information on safe and effective methods of self-managed abortion and to dismantle barriers to clinical abortion care so that TGE people may freely choose a safe, effective abortion in either setting.
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Affiliation(s)
| | - Laura Fix
- Ibis Reproductive Health, Cambridge, Massachusetts, USA
| | | | | | - Jen Hastings
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, California, USA
| | - Ari Stoeffler
- Ibis Reproductive Health, Cambridge, Massachusetts, USA
| | - Eli A Goldberg
- Department of Family Medicine, The Robert Larner, M.D. College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | - Mitchell R Lunn
- Department of Nephrology, Stanford University School of Medicine, Stanford, California, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
- The PRIDE Study, Stanford University, Stanford, California, USA
| | - Annesa Flentje
- The PRIDE Study, Stanford University, Stanford, California, USA
- Department of Community Health Systems, University of California San Francisco, San Francisco, California, USA
- Alliance Health Project, Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Matthew R Capriotti
- The PRIDE Study, Stanford University, Stanford, California, USA
- Department of Psychology, San Jose State University, San Jose, California, USA
| | - Micah E Lubensky
- The PRIDE Study, Stanford University, Stanford, California, USA
- Department of Community Health Systems, University of California San Francisco, San Francisco, California, USA
| | - Juno Obedin-Maliver
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
- The PRIDE Study, Stanford University, Stanford, California, USA
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA
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Johnson DM, Madera M, Gomperts R, Aiken AR. The economic context of pursuing online medication abortion in the United States. SSM. QUALITATIVE RESEARCH IN HEALTH 2021; 1:100003. [PMID: 35368445 PMCID: PMC8976452 DOI: 10.1016/j.ssmqr.2021.100003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Access to in-clinic abortion has become increasingly restricted in the U.S. and for many, the high cost of care is a significant barrier. However, little is known about how financial circumstances shape the alternate pathways to abortion care people seek when the clinic is out of reach. In a unique sample of people who used medication abortion pills from Aid Access, a non-profit telemedicine service, we examine the impact of economic circumstances on abortion care pathway decision-making and experiences seeking care. Between June and August 2019, we conducted 80 anonymous, semi-structured in-depth interviews with U.S. residents who self-managed their own abortions using medication abortion pills from Aid Access. Participants were asked about their experiences seeking abortion, and their motivations for using the service. We coded interviews using an iteratively developed coding guide and performed thematic analyses to identify key themes. The unaffordable cost of in-clinic abortion was a key reason why participants sought care using online telemedicine. Experiences of personal financial hardship exacerbated by restrictive policies impacted participants' ability to access the clinic. For participants with children, their financial decisions were further guided by the concerns of providing economic stability for their family. Although telemedicine was considered more affordable than in-clinic care, for some, the suggested donation of $90 still posed a financial burden and accessing pills at no cost or a reduced cost was necessary. The availability of affordable telemedicine and policy interventions addressing Medicaid and insurance coverage for abortion would democratize abortion access for populations with low incomes.
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Association of State Gestational Age Limit Abortion Laws With Infant Mortality. Am J Prev Med 2021; 61:787-794. [PMID: 34364724 PMCID: PMC8608731 DOI: 10.1016/j.amepre.2021.05.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 04/27/2021] [Accepted: 05/11/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION A growing number of state legislatures have passed laws that restrict access to abortion care after a specified gestational age (gestational age limit laws). The impact of these laws on maternal and child population health outcomes and inequities is unknown. The objective of this study is to determine whether states that implement gestational age limit laws experience subsequent changes in rates of infant mortality. METHODS Using U.S. population‒based data from the National Center for Health Statistics Linked Infant Birth-Death Files (2005-2017), difference-in-differences models were estimated using multivariable linear regressions to compare the trends in infant mortality (all-cause and cause-specific rates) in states with gestational age limit laws with the trends in states without such laws. Models stratified by maternal racial/ethnic group explored racial heterogeneity in the law's impact. Data were analyzed in 2020. RESULTS This study included 16,232,133 births in states that enacted a gestation age limit abortion law and 36,472,309 births in states that did not from 2005 to 2017. In difference-in-difference analyses, gestational age limit laws were associated with 0.23 excess infant deaths per 1,000 live births (95% CI=0.09, 0.37, p<0.01). In cause-specific analyses, gestational age limit laws were associated with 0.10 additional infant deaths owing to congenital anomalies per 1,000 live births (95% CI=0.03, 0.17, p=0.01). Associations between gestational age limit laws and infant mortality in models stratified by maternal racial/ethnic group were not statistically significant. CONCLUSIONS On the basis of data from 2005 to 2017, states that enacted gestational age limit abortion laws subsequently experienced increased infant mortality rates.
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Sunil B. Running an obstacle-course: a qualitative study of women's experiences with abortion-seeking in Tamil Nadu, India. Sex Reprod Health Matters 2021; 29:e1966218. [PMID: 34651568 PMCID: PMC8525933 DOI: 10.1080/26410397.2021.1966218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Irrespective of the legal status of abortion, access to abortion services for women is fraught with numerous challenges across the world. A recent study in India found that most women who had an abortion sought care outside an authorised facility or from a less qualified provider. An analysis of women’s experiences in seeking abortion services would provide a better understanding of the underlying reasons. This paper is based on a qualitative study of the experiences of 16 married women from rural Tamil Nadu, India. The in-depth interviews focused on their pregnancy and childbirth experiences and access to abortion services. The study highlights the obstacle course that women seeking to terminate an unwanted pregnancy have to traverse. Many women were not aware of the legal status of abortion, and frontline workers discouraged them and gave misleading information. The pathways to seeking an abortion were more complex for women from marginalised communities. Providers were judgemental and used delaying tactics or denied abortion services. For the less privileged women, abortion services from government health facilities were conditional on the acceptance of female sterilisation. The providers’ attitudes in government and private health facilities were disrespectful of the women seeking abortion services. To uphold the reproductive and human rights of women who seek abortion services, we need accessible and publicly funded health care services that respect the dignity of all women, are empathetic and uphold women’s right to safe abortion services.
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Kimport K, Littlejohn K. Abortion as obtainable: Insights into how pregnant people in the United States who considered abortion understand abortion availability . Contraception 2021; 106:45-48. [PMID: 34587503 DOI: 10.1016/j.contraception.2021.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE In the United States, restrictive abortion policies are concentrated in a subset of states. Little research has examined how people who consider abortion make sense of abortion obtainability and the extent of regulation of abortion care in their state. STUDY DESIGN We conducted in-depth interviews with 30 pregnant women in Maryland, a state with high abortion service availability and few policies restricting abortion, and 28 pregnant women in Louisiana, a state with low service availability and numerous restrictions, who had considered but not obtained an abortion for their pregnancy. We analyzed findings using inductive qualitative analytic techniques. RESULTS All participants were financially struggling. Most participants in Maryland considered abortion easy to get, while a plurality of participants in Louisiana considered abortion difficult to get. Yet, despite their measurable differences in access, participants in both states considered abortion generally obtainable. Participants in Louisiana who thought abortion difficult to get, but nonetheless obtainable, cited strategies that they already employed for other challenges in their lives as options for overcoming abortion barriers. CONCLUSIONS Pregnant women who consider abortion and are subject to restrictions do not necessarily perceive restrictions as barriers. Their accounts illustrate how those impacted by restrictions adapt to constraints on their reproductive autonomy just as they manage many other challenges that restrict their freedom to live self-determined lives. IMPLICATIONS Financially struggling pregnant people who considered abortion in Louisiana did not perceive restrictions as barriers to abortion, illustrating the broader adoption of strategies to deal with constraints among women living on low incomes.
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Affiliation(s)
- Katrina Kimport
- Advancing New Standards in Reproductive Health, University of California, San Francisco, Oakland, CA, United States.
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Kimport K, Littlejohn KE. What are We Forgetting? Sexuality, Sex, and Embodiment in Abortion Research. JOURNAL OF SEX RESEARCH 2021; 58:863-873. [PMID: 34080946 DOI: 10.1080/00224499.2021.1925620] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Abortion has been alternately legalized and criminalized, tacitly approved of, and stigmatized, in various settings over time. The contours of its treatment are dependent on social and political contexts, including concern over women's sexuality, but it is not clear that existing conceptual frameworks enable expansive examination of the relationship between abortion and sexuality. We conduct a critical interpretive synthesis review of the literature that jointly engages with sexuality and abortion, focusing on the U.S., to highlight the frameworks that authors use to understand the relationship between the two. We find two conceptual frameworks of abortion and sexuality in operation: one that treats the two as discrete, causal variables that operate at the individual level; and another that focuses on how beliefs about what constitutes (in)appropriate sexuality explain ideological positions on abortion. We identify limitations of both frameworks and propose a new conceptual framework - one that highlights sexual embodiment - to inspire future research in this area and generate opportunities for knowledge extension. Such an approach, we contend, can elucidate broader social forces that shape both abortion and sexuality and bring research on abortion into conversation with recent scholarship on the important role of sexuality in other sexual and reproductive domains.
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Affiliation(s)
- Katrina Kimport
- Advancing New Standards in Reproductive Health, University of California
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Real-Time Effects of Payer Restrictions on Reproductive Healthcare: A Qualitative Analysis of Cost-Related Barriers and Their Consequences among U.S. Abortion Seekers on Reddit. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179013. [PMID: 34501602 PMCID: PMC8430941 DOI: 10.3390/ijerph18179013] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/20/2021] [Accepted: 08/22/2021] [Indexed: 01/07/2023]
Abstract
Objective: The Hyde Amendment and related policies limit or prohibit Medicaid coverage of abortion services in the United States. Most research on cost-related abortion barriers relies on clinic-based samples, but people who desire abortions may never make it to a healthcare center. To examine a novel, pre-abortion population, we analyzed a unique qualitative dataset of posts from Reddit, a widely used social media platform increasingly leveraged by researchers, to assess financial obstacles among anonymous posters considering abortion. Methods: In February 2020, we used Python to web-scrape the 250 most recent posts that mentioned abortion, removing all identifying information and usernames. After transferring all posts into NVivo, a qualitative software package, the team identified all datapoints related to cost. Three qualitatively trained evaluators established and applied codes, reaching saturation after 194 posts. The research team used a descriptive qualitative approach, using both inductive and deductive elements, to identify and analyze themes related to financial barriers. Results: We documented multiple cost-related deterrents, including lack of funds for both the procedure and attendant travel costs, inability to afford desired abortion modality (i.e., medication or surgical), and for some, consideration of self-managed abortion options due to cost barriers. Conclusions: Findings from this study underscore the centrality of cost barriers and third-party payer restrictions to stymying reproductive health access in the United States. Results may contribute to the growing evidence base and building political momentum focused on repealing the Hyde Amendment.
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Foster DG, Gould H, Biggs MA. Timing of pregnancy discovery among women seeking abortion . Contraception 2021; 104:642-647. [PMID: 34363842 DOI: 10.1016/j.contraception.2021.07.110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 07/23/2021] [Accepted: 07/28/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Little is known about the incidence and causes of delay in recognition of pregnancy. Delay in pregnancy recognition is associated with later presentation for abortion and exacerbates the burdens in accessing care. Using Turnaway study data, this study assessed the prevalence of later pregnancy recognition among a sample of people who obtained or were denied a wanted abortion. STUDY DESIGN The Turnaway Study included telephone interviews of 956 women who sought an abortion in the first trimester or just over or under the gestational limit of one of 30 abortion facilities across the United States and in-depth interviews with 31 who completed 5 years of surveys. We describe women's experiences discovering pregnancy and conducted multivariate analyses assessing factors associated with later pregnancy discovery (after 13 weeks since last menstrual period [LMP]). RESULTS Most women seeking second trimester abortions recognized their pregnancy more than 8 weeks after their LMP; more than 1 in 5 recognized pregnancy after 20 weeks. In interviews, women explained that recognition was delayed because of a lack of pregnancy symptoms or concurrence of other conditions with symptoms similar to pregnancy. According to multivariate analyses, women who had never given birth (adjusted odds ratio [aOR] = 1.71; 95% confidence interval [CI]: 1.24, 2.35) and those who used hormonal contraceptives in the month of conception (aOR = 1.83; 95% CI: 1.35, 2.47) were more likely to discover pregnancy after 13 weeks. CONCLUSION Laws imposing gestational limits will make abortion unavailable to people who discover pregnancy after the limit. Such bans are likely to disproportionately affect people using contraceptive methods to prevent pregnancy and those who have never given birth. IMPLICATIONS Some pregnant people have few pregnancy symptoms and/or have conditions with symptoms similar to pregnancy, such as irregular periods or chronic pain. Gestational limits to abortion are likely to disproportionately affect people who recognize pregnancy later in pregnancy, particularly those without prior pregnancy experiences and who are using contraception.
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The disproportionate burdens of the mifepristone REMS. Contraception 2021; 104:16-19. [DOI: 10.1016/j.contraception.2021.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/28/2021] [Accepted: 05/02/2021] [Indexed: 11/23/2022]
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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: 19] [Impact Index Per Article: 6.3] [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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Garnsey C, Zanini G, De Zordo S, Mishtal J, Wollum A, Gerdts C. Cross-country abortion travel to England and Wales: results from a cross-sectional survey exploring people's experiences crossing borders to obtain care. Reprod Health 2021; 18:103. [PMID: 34022888 PMCID: PMC8141157 DOI: 10.1186/s12978-021-01158-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/13/2021] [Indexed: 11/25/2022] Open
Abstract
Background The laws governing abortion access vary across Europe. Even in countries with relatively liberal laws, numerous barriers to abortion access exist. In response to these barriers, evidence suggests that people living in countries with both restrictive and liberal laws travel outside of their home country for abortion care. England and Wales are common destinations for those who travel to seek abortions, but little is known about the motivations and experiences of those who undertake cross-country travel to England or Wales to obtain care. This paper aims to describe the abortion seeking and travel experiences of women and pregnant people who traveled to England and Wales for an abortion between 2017 and 2019. Methods We recruited 97 participants who had traveled cross-country from both liberal and restrictive contexts to seek abortion care at three participating BPAS clinics in England and Wales. Participants completed an electronic survey about their reproductive histories, abortion decision-making, experiences seeking abortion care, and traveling. We conducted a descriptive analysis, and include comparisons between participants who traveled from liberal and restrictive contexts. Results Over a third of participants considered abortion four weeks or more before presenting for care at BPAS, and around two-thirds sought abortion services in their home country before traveling. The majority of participants indicated that they would have preferred to have obtained an abortion earlier and cited reasons including scheduling issues, a dearth of local services, delayed pregnancy recognition, and financial difficulties as causing their delay. About seventy percent of participants reported travel costs between €101–1000 and 75% of participants reported that the cost of the abortion procedure exceeded €500. About half of participants indicated that, overall, their travel was very or somewhat difficult. Conclusions This analysis documents the burdens associated with cross-country travel for abortion and provides insight into the factors that compel people to travel. Our findings highlight the need for expanded access to abortion care throughout Europe via the removal of legal impediments and other social or procedural barriers. Removing barriers would eliminate the need for cumbersome abortion travel, and ensure that all people can obtain necessary, high-quality healthcare in their own communities. In Europe, people who live in countries where abortion is severely restricted or illegal altogether lack access to abortion care entirely, but even people who live in countries with more liberal laws face barriers due to gestational age limits, waiting periods, and a lack of trained and willing providers. Existing evidence suggests that restrictions and barriers compel people from both countries with restrictive laws as well as those from countries with more liberal laws to travel outside of their home country for abortion services. England and Wales are common destinations for people traveling within Europe to obtain abortion services, but little is known about the experiences of these travelers. We surveyed individuals who had traveled from another country to seek abortion services in England or Wales. Our analysis documents that many participants contemplated getting an abortion and sought care in their home countries before traveling. Likewise, many participants indicated that they would have preferred to have obtained an abortion earlier in their pregnancy, and referenced scheduling issues, a dearth of local services, delayed pregnancy recognition, and financial difficulties as causing their delay. A majority of participants indicated that covering the costs of their abortion, and the costs of travel was difficult, and that the travel experience in its entirety was difficult. Our findings document the reasons for, and burdens associated with abortion travel and highlight the need to expand access to abortion across Europe via the elimination of all legal restrictions and impediments.
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Affiliation(s)
- Camille Garnsey
- Ibis Reproductive Health, 1736 Franklin St, Suite 600, Oakland, CA, 94612, USA
| | - Giulia Zanini
- Department of Anthropology, University of Barcelona, Montalegre, 6-8 08001, Barcelona, Spain
| | - Silvia De Zordo
- Department of Anthropology, University of Barcelona, Montalegre, 6-8 08001, Barcelona, Spain
| | - Joanna Mishtal
- Department of Anthropology, University of Central Florida, 4297 Andromeda Loop, Orlando, FL, 32816, USA
| | - Alexandra Wollum
- Ibis Reproductive Health, 1736 Franklin St, Suite 600, Oakland, CA, 94612, USA
| | - Caitlin Gerdts
- Ibis Reproductive Health, 1736 Franklin St, Suite 600, Oakland, CA, 94612, USA.
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Raifman S, Ralph L, Biggs MA, Grossman D. "I'll just deal with this on my own": a qualitative exploration of experiences with self-managed abortion in the United States. Reprod Health 2021; 18:91. [PMID: 33947413 PMCID: PMC8093912 DOI: 10.1186/s12978-021-01142-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/17/2021] [Indexed: 11/25/2022] Open
Abstract
Background A growing body of evidence indicates that some people seek options to terminate a pregnancy without medical assistance, but experiences doing so have largely been documented only among people accessing a clinic-based abortion. We aim to describe self-managed abortion (SMA) experiences of people recruited outside of clinics, including their motivations for SMA, pregnancy confirmation and decision-making processes, method choices, and clinical outcomes. Methods In 2017, we conducted 14 in-depth interviews with self-identified females of reproductive age who recently reported in an online survey administered to Ipsos’ KnowledgePanel that, since 2000, they had attempted SMA while living in the United States. We asked participants about their reproductive histories, experiences seeking reproductive health care, and SMA experiences. We used an iterative process to develop codes and analyzed transcripts using thematic content analysis methods. Results Motivations and perceptions of effectiveness varied by whether participants had confirmed the pregnancy prior to SMA. Participants who confirmed their pregnancies chose SMA because it was convenient, accessible, and private. Those who did not test for pregnancy were motivated by a preference for autonomy and felt empowered by the ability to try something on their own before seeking facility-based care. Participants prioritized methods that were safe and available, though not always effective. Most used herbs or over-the-counter medications; none used self-sourced abortion medications, mifepristone and/or misoprostol. Five participants obtained facility-based abortions and one participant decided to continue the pregnancy after attempting SMA. The remaining eight reported being no longer pregnant after SMA. None of the participants sought care for SMA complications; one participant saw a provider to confirm abortion completion. Conclusions There are many types of SMA experiences. In addition to those who pursue SMA as a last resort (after facing barriers to facility-based care) or as a first resort (because they prefer homeopathic remedies), our findings show that some individuals view SMA as a potential interim step worth trying after suspecting pregnancy and before accessing facility-based care. These people in particular would benefit from a medication abortion product available over the counter, online, or in the form of a missed-period pill. Some people in the United States (US) attempt to end a pregnancy on their own without medical supervision. What we know about this experience comes from studies focused on people who go to clinics. In this study, we conducted 14 interviews with self-identified women ages 18–49 who recently reported attempting to end a pregnancy on their own and who were recruited outside of the clinic setting. We asked participants about their fertility histories, experiences seeking reproductive health care, and experiences ending a pregnancy without medical assistance. Those who took a pregnancy test and then chose to end the pregnancy on their own did so because it was convenient, accessible, and private. Those who did not test for pregnancy felt empowered by the ability to try something on their own before seeking facility-based care. All participants prioritized methods that were safe and available, though not always effective. After they attempted to end the pregnancy on their own, five participants accessed abortion care in facilities, one decided to continue the pregnancy, and eight were no longer pregnant. Our findings show that, in addition to people who end a pregnancy on their own as a last resort (after facing barriers to facility-based care) or as a first resort (because of preferences for homeopathic methods), a third group values having an interim step to try after suspecting pregnancy and before accessing facility-based care. These people would particularly benefit from a medication abortion product available over the counter, online, or in the form of a missed-period pill.
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Affiliation(s)
- Sarah Raifman
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, 1330 Broadway Suite 1100, Oakland, CA, 94612, USA.
| | - Lauren Ralph
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, 1330 Broadway Suite 1100, Oakland, CA, 94612, USA
| | - M Antonia Biggs
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, 1330 Broadway Suite 1100, Oakland, CA, 94612, USA
| | - Daniel Grossman
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, 1330 Broadway Suite 1100, Oakland, CA, 94612, USA
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Rice WS, Labgold K, Peterson QT, Higdon M, Njoku O. Sociodemographic and Service Use Characteristics of Abortion Fund Cases from Six States in the U.S. Southeast. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073813. [PMID: 33917408 PMCID: PMC8038751 DOI: 10.3390/ijerph18073813] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/02/2021] [Accepted: 04/03/2021] [Indexed: 11/16/2022]
Abstract
Abortion funds are key actors in mitigating barriers to abortion access, particularly in contexts where state-level abortion access restrictions are concentrated. Using 2017–2019 case management data from a regional abortion fund in the southeastern U.S., we described the sociodemographic and service use characteristics of cases overall (n = 9585) and stratified by state of residence (Alabama, Florida, Georgia, Mississippi, South Carolina, and Tennessee). Overall, cases represented people seeking abortion fund assistance who predominately identified as non-Hispanic Black (81%), 18–34 years of age (84%), publicly or uninsured (87%), having completed a high school degree or some college (70%), having one or more children (77%), and as Christian (58%). Most cases involved an in-state clinic (81%), clinic travel distance under 50 miles (63%), surgical abortion (66%), and pregnancy under 13 weeks’ gestation (73%), with variation across states. The median abortion fund contribution pledge was $75 (interquartile range (IQR): 60–100), supplementing median caller contributions of $200 (IQR: 40–300). These data provide a unique snapshot of a population navigating disproportionate, intersecting barriers to abortion access, and abortion fund capacity for social care and science. Findings can inform abortion fund development, data quality improvement efforts, as well as reproductive health, rights and justice advocacy, policy, and research.
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Affiliation(s)
- Whitney S. Rice
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
- The Center for Reproductive Health Research in the Southeast, Rollins School of Public Health, Emory University, Atlanta, GA 30030, USA;
- Correspondence:
| | - Katie Labgold
- The Center for Reproductive Health Research in the Southeast, Rollins School of Public Health, Emory University, Atlanta, GA 30030, USA;
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | | | | | - Oriaku Njoku
- Access Reproductive Care–Southeast, Atlanta, GA 30357, USA; (Q.T.P.); (O.N.)
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Moseson H, Wollum A, Seymour JW, Zuniga C, Thompson TA, Gerdts C. Comparison of Facebook, Google Ads, and Reddit for the Recruitment of People Who Considered but Did Not Obtain Abortion Care in the United States: Cross-sectional Survey. JMIR Form Res 2021; 5:e22854. [PMID: 33625368 PMCID: PMC7946578 DOI: 10.2196/22854] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/30/2020] [Accepted: 01/17/2021] [Indexed: 02/05/2023] Open
Abstract
Background In the United States, abortion access is restricted by numerous logistical, financial, social, and policy barriers. Most studies on abortion-seeking experiences in the United States have recruited participants from abortion clinics. However, clinic-based recruitment strategies fail to capture the experiences of people who consider an abortion but do not make it to an abortion clinic. Research indicates that many people search for abortion information on the web; however, web-based recruitment remains underutilized in abortion research. Objective This study aims to establish the feasibility of using Facebook, Google Ads, and Reddit as recruitment platforms for a study on abortion-seeking experiences in the United States. Methods From August to September 2018, we posted recruitment advertisements for a survey about abortion-seeking experiences through Facebook, Google Ads, and Reddit. Eligible participants were US residents aged 15-49 years who had been pregnant in the past 5 years and had considered abortion for a pregnancy in this period but did not abort. For each platform, we recorded staff time to develop advertisements and manage recruitment, as well as costs related to advertisement buys and social marketing firm support. We summarized the number of views and clicks for each advertisement where possible, and we calculated metrics related to cost per recruited participant and recruitment rate by week for each platform. We assessed differences across platforms using the chi-square and Kruskal-Wallis tests. Results Overall, study advertisements received 77,464 views in the 1-month period (from Facebook and Google; information not available for Reddit) and 2808 study page views. After clicking on the advertisements, there were 1254 initiations of the eligibility screening survey, which resulted in 98 eligible survey participants (75 recruited from Facebook, 14 from Google Ads, and 9 from Reddit). The cost for each eligible participant in each platform was US $49.48 for Facebook, US $265.93 for Google Ads, and US $182.78 for Reddit. A total of 84% (66/79) of those who screened eligible from Facebook completed the short survey compared with 73% (8/11) of those who screened eligible from Reddit and 13% (7/53) of those who screened eligible from Google Ads. Conclusions These results suggest that Facebook advertisements may be the most time- and cost-effective strategy to recruit people who considered but did not obtain an abortion in the United States. Adapting and implementing Facebook-based recruitment strategies for research on abortion access could facilitate a more complete understanding of the barriers to abortion care in the United States.
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Affiliation(s)
- Heidi Moseson
- Ibis Reproductive Health, Oakland, CA, United States
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Upadhyay UD, McCook AA, Bennett AH, Cartwright AF, Roberts SCM. State abortion policies and Medicaid coverage of abortion are associated with pregnancy outcomes among individuals seeking abortion recruited using Google Ads: A national cohort study. Soc Sci Med 2021; 274:113747. [PMID: 33642070 DOI: 10.1016/j.socscimed.2021.113747] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/22/2020] [Accepted: 02/03/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE A major challenge to understanding barriers to abortion is that those individuals most affected may never reach an abortion provider, making the full impact of restrictive policies difficult to measure. The Google Ads Abortion Access Study used a novel method to recruit individuals much earlier in the abortion-seeking process. We aimed to understand how state-level abortion policies and Medicaid coverage of abortion influence individuals' ability to obtain wanted abortions. METHODS We employed a stratified sampling design to recruit a national cohort from all 50 states searching Google for abortion care. Participants completed online baseline and 4-week follow-up surveys. The primary independent variables were: 1) state policy environment and 2) state coverage of abortion for people with Medicaid. We developed multivariable multinomial mixed effects models to estimate the associations between each state-level independent variable and pregnancy outcome. RESULTS Of the 874 participants with follow-up data, 48% had had an abortion, 32% were still seeking an abortion, and 20% were planning to continue their pregnancies at 4 weeks follow-up. Individuals in restricted access states had significantly higher odds of planning to continue the pregnancy at follow-up than participants in protected access states (aOR = 1.70, 95% CI = 1.08, 2.70). Individuals in states that do not provide coverage of abortion for people with Medicaid had significantly higher odds of still seeking an abortion at follow-up (aOR = 1.80, 95% CI = 1.24, 2.60). Individuals living in states without Medicaid coverage were significantly more likely to report that having to gather money to pay for travel expenses or for the abortion was a barrier to care. CONCLUSIONS Restrictive state-level abortion policies are associated with not having an abortion at all and lack of coverage for abortion is associated with prolonged abortion seeking. Medicaid coverage of abortion appears critical to ensuring that all people who want abortions can obtain them.
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Affiliation(s)
- Ushma D Upadhyay
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, USA.
| | - Ashley A McCook
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, USA
| | - Ariana H Bennett
- School of Public Health, University of California, Berkeley, USA
| | - Alice F Cartwright
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA; Carolina Population Center, University of North Carolina at Chapel Hill, USA
| | - Sarah C M Roberts
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, USA
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Garnsey C, Wollum A, Garduño Huerta S, Uribe OL, Keefe-Oates B, Baum SE. Factors influencing abortion decisions, delays, and experiences with abortion accompaniment in Mexico among women living outside Mexico City: results from a cross-sectional study. Sex Reprod Health Matters 2021; 29:2038359. [PMID: 35262471 PMCID: PMC8920378 DOI: 10.1080/26410397.2022.2038359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Access to abortion throughout much of Mexico has been restricted. Fondo Maria is an abortion accompaniment fund that provides informational, logistical, financial, and emotional support to people seeking abortion care in Mexico. This cross-sectional study examines the factors that influenced decision-making and contributed to delays in accessing care and explores experiences with Fondo Maria’s support among women living outside Mexico City (CDMX). We describe and compare the experiences of women across the sample (n = 103) who were either supported by Fondo Maria to travel to CDMX to obtain an abortion (n = 60), or self-managed a medical abortion in their home state (n = 43). Data were collected between January 2017 and July 2018. Seventy-seven percent of participants reported that it was difficult to access abortion care in their home state and 34% of participants indicated they were delayed in accessing care, primarily due to a lack of financial support. The majority of participants (58%) who travelled to CDMX for their abortion did so because it seemed safer. The money/cost of the trip was the most commonly cited reason (33%) why participants who self-managed stayed in their home state. Eighty-seven percent of participants said Fondo Maria’s services met or exceeded their expectations. Our data suggest that people seeking abortion and living outside CDMX face multiple and overlapping barriers that can delay care-seeking and influence decision-making. Abortion accompaniment networks, such as Fondo Maria, offer a well-received model of support for people seeking abortion in restrictive states across Mexico.
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Affiliation(s)
- Camille Garnsey
- Research Assistant, Ibis Reproductive Health, Cambridge MA & Oakland, CA, USA
| | - Alexandra Wollum
- Senior Associate Research Scientist, Ibis Reproductive Health, Cambridge MA & Oakland, CA, USA
| | | | | | - Brianna Keefe-Oates
- Senior Project Manager, Ibis Reproductive Health, Cambridge MA & Oakland, CA, USA
| | - Sarah E Baum
- Senior Research Scientist, Ibis Reproductive Health, Cambridge MA & Oakland, CA, USA
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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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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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Assifi AR, Kang M, Sullivan EA, Dawson AJ. Abortion care pathways and service provision for adolescents in high-income countries: A qualitative synthesis of the evidence. PLoS One 2020; 15:e0242015. [PMID: 33166365 PMCID: PMC7652292 DOI: 10.1371/journal.pone.0242015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 10/25/2020] [Indexed: 11/29/2022] Open
Abstract
Limited research in high-income countries (HICs) examines adolescent abortion care-seeking pathways. This review aims to examine the pathways and experiences of adolescents when seeking abortion care, and service delivery processes in provision of such care. We undertook a systematic search of the literature to identify relevant studies in HICs (2000–2020). A directed content analysis of qualitative and quantitative studies was conducted. Findings were organised to one or more of three domains of an a priori conceptual framework: context, components of abortion care and access pathway. Thirty-five studies were included. Themes classified to the Context domain included adolescent-specific and restrictive abortion legislation, mostly focused on the United States. Components of abortion care themes included confidentiality, comprehensive care, and abortion procedure. Access pathway themes included delays to access, abortion procedure information, decision-making, clinic operation and environments, and financial and transportation barriers. This review highlights issues affecting access to abortion that are particularly salient for adolescents, including additional legal barriers and challenges receiving care due to their age. Opportunities to enhance abortion access include removing legal barriers, provision of comprehensive care, enhancing the quality of information, and harnessing innovative delivery approaches offered by medical abortion.
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Affiliation(s)
- Anisa R. Assifi
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, Australia
- * E-mail:
| | - Melissa Kang
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Elizabeth A. Sullivan
- Office of the PVC Health and Medicine, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia
| | - Angela J. Dawson
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, Australia
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Tufa TH, Prager S, Lavelanet AF, Kim C. Drugs used to induce fetal demise prior to abortion: a systematic review. Contracept X 2020; 2:100046. [PMID: 33294839 PMCID: PMC7689273 DOI: 10.1016/j.conx.2020.100046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 10/17/2020] [Accepted: 10/19/2020] [Indexed: 11/26/2022] Open
Abstract
Clinicians have used feticidal agents prior to second trimester abortion for many years. Despite the widespread use of various agents to induce fetal demise, a comprehensive or systematic review of the evidence is lacking on the safety, effectiveness, and most effective routes of administration. Objectives To evaluate the existing drugs and routes of administration used in inducing fetal demise prior to abortion, and to determine the safety, effectiveness, and acceptability of these feticidal agents. Methods We searched PubMed, EMBASE, CINAHL, POPLINE, and Global Index Medicus to identify studies describing pharmacologic agents used to induce fetal demise prior to termination of pregnancy. We included randomized controlled trials and observational studies comparing digoxin, potassium chloride (KCL), and lidocaine to induce fetal demise. We included studies that evaluated the primary outcomes of safety and effectiveness, including success in achieving fetal demise, induction to expulsion time for medical abortion, dilation and evacuation time, as well as maternal side effects and complications. Two authors independently screened abstracts and full texts. One reviewer extracted data from the included studies, which was counterchecked by a second reviewer. Results We identified eight studies that met inclusion criteria: three randomized controlled trials, and five observational studies. A total of 4505 women received drugs to induce fetal demise at 17 to 38 weeks' gestation, including digoxin (n = 4174), KCL (n = 324), and lidocaine (n = 7). Intra-fetal digoxin was superior to intra-amniotic digoxin in achieving fetal demise (OR 3.51, 95% CI 1.60, 7.78). Intracardiac KCL 15% 2–3 mL reduced induction to expulsion time by 320 min (p <.006). Similarly, intracardiac KCL 15% 1–3 ml reduced dilation and evacuation time from 16.1 ± 7.9 min to 12.7 ± 5 min (p < 0.001). Intracardiac lidocaine 2% 10 mL was more effective at achieving fetal demise than intracardiac KCL 6 mmol (85.7% vs. 57.9%). Intra-amniotic and intra-fetal digoxin 1 mg, as compared to no feticidal agent, led to greater pre-procedure expulsion, hospital readmission, and the presence of one or more signs of infection. Conclusions Evidence from included cohort studies demonstrates that digoxin, KCL, and lidocaine are all effective in inducing fetal demise. Intra-fetal administration of digoxin is superior to intra-amniotic digoxin administration. Administration of feticide using intracardiac KCL may shorten the abortion experience. Limited data from observational studies also supports an increase in maternal side effects and/or complications related to the administration of digoxin. Implications Intra-fetal administration of digoxin is more effective in achieving fetal demise when compared to intra-amniotic administration. There is a knowledge gap in determining the single best drug for inducing fetal demise prior to abortion. Additional research is needed to compare different feticidal agents in terms of safety and effectiveness.
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Affiliation(s)
- Tesfaye H Tufa
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.,UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Sarah Prager
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.,Department of Obstetrics & Gynecology, University of Washington, Seattle, Washington, USA
| | - Antonella F Lavelanet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Caron Kim
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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