1
|
Mackinnon Krems J, Grossman D, Ehrenreich K, Ralph L. Money and place: Quantifying the types of obstacles associated with seeking an abortion after 10 weeks' gestation, 2019-2020. Contraception 2024; 136:110476. [PMID: 38679274 DOI: 10.1016/j.contraception.2024.110476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 04/19/2024] [Accepted: 04/23/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVES Identify factors associated with presenting for abortion after 10 weeks' gestation in a large, geographically diverse sample. STUDY DESIGN From October 2019 to March 2020, we surveyed 1089 patients seeking abortion at seven U.S. facilities. We identified four domains of barriers: geographic, financial, logistical/personal, and legislative. Using multivariable logistic regression, we investigated the relationship between each domain and presenting for abortion after 10 weeks' gestation, overall and stratified by state policy landscape. RESULTS One-third of participants reported geographic (33.0%), financial (33.3%), and logistical/personal (31.4%) barriers; fewer (4.8%) reported legislative barriers. One-third (30.8%) traveled over 50 miles to the clinic. One-quarter (25.2%) presented after 10 weeks' gestation. In multivariable analyses, financial barriers (adjusted odds ratio [aOR] = 1.49, 95% confidence interval [CI] = 1.06-2.09), geographic barriers (aOR = 2.05, 95% CI = 1.44-2.90), and difficulty meeting basic expenses (aOR = 1.47, 95% CI = 1.15-1.89) were associated with presenting after 10 weeks' gestation across the seven clinics. Among participants accessing care at clinics in states with supportive abortion policies (n = 178), geographic barriers remained significantly associated with presenting after 10 weeks' gestation. CONCLUSIONS In a large, geographically diverse sample, financial and geographic barriers were associated with presenting after the threshold for medication abortion. In supportive states, the association with geographic barriers persisted. Cost and geographic barriers are increasing as more states restrict abortion post-Dobbs, highlighting the urgent need to expand financial and travel support. IMPLICATIONS People seeking abortion faced barriers before the Dobbs decision. Now, post-Dobbs, restrictions to abortion have only increased, making barriers to care even more threatening. Providing access to financial resources and transportation for people seeking abortion and expanding telehealth medication for abortion is now even more important.
Collapse
Affiliation(s)
- Jennifer Mackinnon Krems
- Joint Medical Program, University of California San Francisco and University of California Berkeley, San Francisco and Berkeley, CA, USA.
| | - Daniel Grossman
- Advancing New Standards in Reproductive Health, Department of Obstetrics Gynecology and Reproductive Sciences, University of California San Francisco, Oakland, CA, USA
| | - Katherine Ehrenreich
- Advancing New Standards in Reproductive Health, Department of Obstetrics Gynecology and Reproductive Sciences, University of California San Francisco, Oakland, CA, USA
| | - Lauren Ralph
- Advancing New Standards in Reproductive Health, Department of Obstetrics Gynecology and Reproductive Sciences, University of California San Francisco, Oakland, CA, USA
| |
Collapse
|
2
|
Cartwright AF, Braccia A, Chiu DW, Jones RK. Characteristics of foreign-born abortion patients in the United States, 2021-2022. Contraception 2024:110553. [PMID: 39089664 DOI: 10.1016/j.contraception.2024.110553] [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: 04/05/2024] [Revised: 07/24/2024] [Accepted: 07/25/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVES To examine the characteristics of foreign-born abortion patients compared to those born in the Unites States (US) and to explore whether barriers for foreign-born patients varied by state Medicaid coverage of abortion care. STUDY DESIGN We used data from the Guttmacher Institute's 2021-2022 Abortion Patient Survey, a national sample of patients obtaining clinic-based abortion care in the US. We compared sociodemographic characteristics of foreign- and US-born respondents, as well as barriers to care. Among foreign-born patients, we compared those in Medicaid coverage states vs. states that restrict Medicaid coverage. RESULTS Some 12% of the 6,429 respondents were born outside the US. Compared to US-born patients, they were less likely to have Medicaid coverage and more likely to be Asian/Native Hawaiian/Pacific Islander or Hispanic, to have no health insurance, and to have completed the survey in Spanish. In addition, foreign-born patients were more likely to report delays because they did not know where to get an abortion (18.3% vs. 12.6% for US-born). Compared to foreign-born patients living in Medicaid coverage states, those in non-Medicaid states reported multiple barriers, particularly related to cost: respondents in non-Medicaid states were 3 times as likely to pay out of pocket for abortion (75.8% vs. 27.4%) and 5 times more likely to rely on financial assistance (24.1% vs. 4.8%). CONCLUSIONS Foreign-born abortion patients face knowledge and financial barriers to accessing abortion care compared to those who are US-born, and these financial burdens are amplified for those living in non-Medicaid coverage states. IMPLICATIONS Abortion patients born outside the US may have overcome many obstacles to obtain care. Expanding state Medicaid coverage of abortion could reduce cost burdens for foreign-born populations.
Collapse
Affiliation(s)
| | - Ava Braccia
- Guttmacher Institute, 125 Maiden Lane, 7th Floor, New York, NY, 10038
| | - Doris W Chiu
- Guttmacher Institute, 125 Maiden Lane, 7th Floor, New York, NY, 10038
| | - Rachel K Jones
- Guttmacher Institute, 125 Maiden Lane, 7th Floor, New York, NY, 10038
| |
Collapse
|
3
|
Upadhyay UD, Schroeder R, Kaller S, Stewart C, Berglas NF. Pricing of medication abortion in the United States, 2021-2023. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2024. [PMID: 38956948 DOI: 10.1111/psrh.12280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
INTRODUCTION Financial costs remain one of the greatest barriers to abortion, leading to delays in care and preventing some from getting a desired abortion. Medication abortion is available through in-person facilities and telehealth services. However, whether telehealth offers a more affordable option has not been well-documented. METHODS We used Advancing New Standards in Reproductive Health (ANSIRH)'s Abortion Facility Database, which includes data on all publicly advertising abortion facilities and is updated annually. We describe facility out-of-pocket prices for medication abortion in 2021, 2022, and 2023, comparing in-person and telehealth provided by brick-and-mortar and virtual clinics, and by whether states allowed Medicaid coverage for abortion. RESULTS The national median price for medication abortion remained consistent at $568 in 2021 and $563 in 2023. However, medications provided by virtual clinics were notably lower in price than in-person care and this difference widened over time. The median cost of a medication abortion offered in-person increased from $580 in 2021 to $600 by 2023, while the median price of a medication abortion offered by virtual clinics decreased from $239 in 2021 to $150 in 2023. Among virtual clinics, few (7%) accepted Medicaid. Median prices in states that accept Medicaid were generally higher than in states that did not. DISCUSSION Medication abortion is offered at substantially lower prices by virtual clinics. However, not being able to use Medicaid or other insurance may make telehealth cost-prohibitive for some people, even if prices are lower. Additionally, many states do not allow telehealth for abortion, deepening inequities in healthcare.
Collapse
Affiliation(s)
- Ushma D Upadhyay
- Advancing New Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California, USA
| | - Rosalyn Schroeder
- Advancing New Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California, USA
| | - Shelly Kaller
- Advancing New Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California, USA
| | - Clara Stewart
- Advancing New Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California, USA
| | - Nancy F Berglas
- Advancing New Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California, USA
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Chiu DW, Braccia A, Jones RK. Characteristics and Circumstances of Adolescents Obtaining Abortions in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:477. [PMID: 38673388 PMCID: PMC11050360 DOI: 10.3390/ijerph21040477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/01/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024]
Abstract
The purpose of this study is to describe the sociodemographic and situational circumstances of adolescents obtaining abortion in the United States prior to the Dobbs decision. We use data from the Guttmacher Institute's 2021-2022 Abortion Patient Survey, a cross-sectional survey of 6698 respondents; our analytic sample includes 633 adolescents (<20 years), 2152 young adults (20-24 years), and 3913 adults (25+ years). We conducted bivariate analyses to describe the characteristics and logistical and financial circumstances of adolescents obtaining abortions in comparison to respondents in the other age groups. The majority of adolescents identified as non-white (70%), and 23% identified as something other than heterosexual. We found that 26% of adolescents reported having no health insurance, and two-thirds of adolescent respondents reported that somebody had driven them to the facility. Adolescents differed from adults in their reasons for delays in accessing care; a majority of adolescents (57%) reported not knowing they were pregnant compared to 43% of adults, and nearly one in five adolescents did not know where to obtain the abortion compared to 11% of adults. Adolescents were more likely than adults to obtain a second-trimester abortion, which has increased costs. This study found that this population was more vulnerable than adults on several measures. Findings suggest that adolescents navigate unique barriers with regard to information and logistics to access abortion care.
Collapse
Affiliation(s)
- Doris W. Chiu
- Guttmacher Institute, New York, NY 10038, USA; (A.B.); (R.K.J.)
| | | | | |
Collapse
|
6
|
Jacques LH, Cowley ES, Hebgen SM, Spencer RJ, Hale CM. Obstetrics and gynecology applicant perceptions of residency program culture with virtual interviews: a qualitative analysis of social media posts. BMC MEDICAL EDUCATION 2024; 24:252. [PMID: 38459487 PMCID: PMC10921724 DOI: 10.1186/s12909-024-05175-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 02/13/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND In the United States, Obstetrics and Gynecology residency interviews are instrumental in assessing the compatibility between medical student applicants and residency programs during the match process. Applicant perceptions of Obstetrics and Gynecology residency culture are a key component in determining how they rank residency programs. In 2020, residency interviews transitioned to a virtual format, and little is known about how applicants evaluated program culture during this first round of universal virtual interviews. Medical students in the United States commonly use Reddit, a popular social media platform, to discuss residency programs and share interview experiences. We explored Obstetrics and Gynecology applicants' considerations regarding residency program culture during the first universal virtual interview season in 2020-2021 by analyzing posts on a Google spreadsheet accessed through Reddit. METHODS In 2022, we imported 731 posts from the "2020-21 OB GYN Residency Applicant Spreadsheet" Google spreadsheet posted to the 2020-2021 Residency Interview Spreadsheet megathread on the r/medicalschool subreddit to NVivo 12(QSR International, Burlington, MA), a qualitative analysis software program. Three investigators used qualitative inductive techniques to code and identify themes. RESULTS Applicants used visual, verbal and behavioral cues during virtual Obstetrics and Gynecology residency interviews to understand three components of the workplace culture: prioritization of diversity, equity and inclusion, social environment, and resident workload. CONCLUSIONS Obstetrics and Gynecology residency programs convey information about their culture during virtual interviews through the behavior, appearances and responses of residents and interviewers to applicant questions. To ensure they accurately represent their culture to applicants, programs should consider educating residents and faculty around the implications of interview-day conduct.
Collapse
Affiliation(s)
- Laura H Jacques
- Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin-Madison, McConnell Hall, 4th Floor, 1010 Mound St, 53715, Madison, WI, USA.
| | - Elise S Cowley
- Department of Bacteriology, University of Wisconsin-Madison, 1550 Linden Dr, 53706, Madison, WI, USA
- Microbiology Doctoral Training Program, University of Wisconsin-Madison, 1550 Linden Dr, 53706, Madison, WI, USA
| | - Shanaya M Hebgen
- Doctor of Medicine program, University of Wisconsin School of Medicine and Public Health, 750 Highland Ave, 53726, Madison, WI, USA
| | - Ryan J Spencer
- Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin-Madison, McConnell Hall, 4th Floor, 1010 Mound St, 53715, Madison, WI, USA
| | - Corinne M Hale
- Department of Anthropology, University of Wisconsin-Madison, 1180 Observatory Dr, 53706, Madison, WI, USA
| |
Collapse
|
7
|
Lands M, Dyer RL, Seymour JW. Sampling strategies among studies of barriers to abortion in the United States: A scoping review of abortion access research. Contraception 2024; 131:110342. [PMID: 38012964 DOI: 10.1016/j.contraception.2023.110342] [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: 02/06/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVES Understanding barriers to abortion care is particularly important post-Dobbs. However, many abortion access studies recruit from abortion-providing facilities, which overlook individuals who do not present for clinic-based care. To our knowledge, no studies have reviewed research recruitment strategies in the literature or considered how they might affect our knowledge of abortion barriers. We aimed to identify populations included and sampling methods used in studies of abortion barriers in the United States. STUDY DESIGN We used a scoping review protocol to search five databases for articles examining US-based individuals' experiences accessing abortion. We included English-language articles published between January 2011 and February 2022. For included studies, we identified the sampling strategy and population recruited. RESULTS Our search produced 2763 articles, of which 71 met inclusion criteria. Half of the included papers recruited participants at abortion-providing facilities (n = 35), while the remainder recruited from online sources (n = 14), other health clinics (n = 10), professional organizations (n = 8), abortion funds (n = 2), community organizations (n = 2), key informants (n = 2), and an abortion storytelling project (n = 1). Most articles (n = 61) reported information from people discussing their own abortions; the rest asked nonabortion seekers (e.g., physicians, genetic counselors, attorneys) about barriers to care. CONCLUSIONS Studies of abortion barriers enroll participants from a range of venues, but the majority recruit people who obtained abortions, and half recruit from abortion clinics. IMPLICATIONS As abortion access becomes constrained and criminalized in the post-Roe context, our findings indicate how investigators might recruit study participants from a variety of settings to fully understand the abortion seeking experience.
Collapse
Affiliation(s)
- Madison Lands
- University of Wisconsin Collaborative for Reproductive Equity, Madison, WI, United States.
| | - Rachel L Dyer
- University of Wisconsin Collaborative for Reproductive Equity, Madison, WI, United States; University of Wisconsin Department of Counseling Psychology, Madison, WI, United States
| | - Jane W Seymour
- University of Wisconsin Collaborative for Reproductive Equity, Madison, WI, United States
| |
Collapse
|
8
|
Valdez D, Mena-Meléndez L, Crawford BL, Jozkowski KN. Analyzing Reddit Forums Specific to Abortion That Yield Diverse Dialogues Pertaining to Medical Information Seeking and Personal Worldviews: Data Mining and Natural Language Processing Comparative Study. J Med Internet Res 2024; 26:e47408. [PMID: 38354044 PMCID: PMC10902765 DOI: 10.2196/47408] [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: 03/18/2023] [Revised: 09/27/2023] [Accepted: 12/20/2023] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Attitudes toward abortion have historically been characterized via dichotomized labels, yet research suggests that these labels do not appropriately encapsulate beliefs on abortion. Rather, contexts, circumstances, and lived experiences often shape views on abortion into more nuanced and complex perspectives. Qualitative data have also been shown to underpin belief systems regarding abortion. Social media, as a form of qualitative data, could reveal how attitudes toward abortion are communicated publicly in web-based spaces. Furthermore, in some cases, social media can also be leveraged to seek health information. OBJECTIVE This study applies natural language processing and social media mining to analyze Reddit (Reddit, Inc) forums specific to abortion, including r/Abortion (the largest subreddit about abortion) and r/AbortionDebate (a subreddit designed to discuss and debate worldviews on abortion). Our analytical pipeline intends to identify potential themes within the data and the affect from each post. METHODS We applied a neural network-based topic modeling pipeline (BERTopic) to uncover themes in the r/Abortion (n=2151) and r/AbortionDebate (n=2815) subreddits. After deriving the optimal number of topics per subreddit using an iterative coherence score calculation, we performed a sentiment analysis using the Valence Aware Dictionary and Sentiment Reasoner to assess positive, neutral, and negative affect and an emotion analysis using the Text2Emotion lexicon to identify potential emotionality per post. Differences in affect and emotion by subreddit were compared. RESULTS The iterative coherence score calculation revealed 10 topics for both r/Abortion (coherence=0.42) and r/AbortionDebate (coherence=0.35). Topics in the r/Abortion subreddit primarily centered on information sharing or offering a source of social support; in contrast, topics in the r/AbortionDebate subreddit centered on contextualizing shifting or evolving views on abortion across various ethical, moral, and legal domains. The average compound Valence Aware Dictionary and Sentiment Reasoner scores for the r/Abortion and r/AbortionDebate subreddits were 0.01 (SD 0.44) and -0.06 (SD 0.41), respectively. Emotionality scores were consistent across the r/Abortion and r/AbortionDebate subreddits; however, r/Abortion had a marginally higher average fear score of 0.36 (SD 0.39). CONCLUSIONS Our findings suggest that people posting on abortion forums on Reddit are willing to share their beliefs, which manifested in diverse ways, such as sharing abortion stories including how their worldview changed, which critiques the value of dichotomized abortion identity labels, and information seeking. Notably, the style of discourse varied significantly by subreddit. r/Abortion was principally leveraged as an information and outreach source; r/AbortionDebate largely centered on debating across various legal, ethical, and moral abortion domains. Collectively, our findings suggest that abortion remains an opaque yet politically charged issue for people and that social media can be leveraged to understand views and circumstances surrounding abortion.
Collapse
Affiliation(s)
- Danny Valdez
- Department of Applied Health Science, Indiana University School of Public Health, Bloomington, IN, United States
| | - Lucrecia Mena-Meléndez
- Department of Applied Health Science, Indiana University School of Public Health, Bloomington, IN, United States
| | - Brandon L Crawford
- Department of Applied Health Science, Indiana University School of Public Health, Bloomington, IN, United States
| | - Kristen N Jozkowski
- Department of Applied Health Science, Indiana University School of Public Health, Bloomington, IN, United States
| |
Collapse
|
9
|
Jung C, Nippita S. Self-managed Medication Abortion in the United States. Clin Obstet Gynecol 2023; 66:739-748. [PMID: 37750672 DOI: 10.1097/grf.0000000000000810] [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: 09/27/2023]
Abstract
Self-managed abortion (SMA) is ending a pregnancy without medical supervision, either by obtaining medications (known as self-managed medication abortion) or through other means. Many factors influence a person's decision to pursue self-managed abortion, such as time constraints, financial considerations, and local availability of abortion services. We present on the prevalence, methods and best practices for clinicians in the United States who may interface with individuals undergoing self-managed medication abortion at any point in the process through a harm reduction approach.
Collapse
Affiliation(s)
- Christina Jung
- Department of Obstetrics and Gynecology, NYU Grossman School of Medicine, New York, New York
| | | |
Collapse
|
10
|
White K, Leyser-Whalen O, Whitfield B, Dane'el A, Andrea A, Rupani A, Kumar B, Moayedi G. Abortion assistance fund staff and volunteers as patient navigators following an abortion ban in Texas. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2023:10.1363/psrh.12240. [PMID: 37491624 PMCID: PMC10808264 DOI: 10.1363/psrh.12240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
CONTEXT Abortion assistance funds constitute an important part of the healthcare safety net by covering some of abortion patients' out-of-pocket costs. Few studies have examined the other ways abortion assistance fund staff and volunteers support callers who need help obtaining care. METHODS Between June and September 2020, we conducted in-depth interviews with 23 staff and volunteers at 11 local abortion assistance funds that helped Texans seeking abortion care following a March 2020 state executive order that prohibited most abortions. Interviewers explored respondents' experiences with callers whose appointments had been canceled or who traveled out of state and subsequent operational changes. We used both inductive and deductive codes in the thematic analysis. RESULTS Abortion assistance fund staff and volunteers bridged callers' information gaps about the services and financial resources available and helped create plans to secure care that accounted for callers' specific needs. They provided emotional support so callers felt it was possible to overcome logistical hurdles to get an abortion, even if that required out-of-state travel. Respondents described greater collaboration between Texas-based abortion assistance funds and out-of-state organizations to support callers' more complex logistical needs and increased costs. Some callers who encountered multiple barriers to care, including interpersonal violence, were unable to obtain an abortion, even with additional supports. CONCLUSIONS Local abortion assistance funds worked with Texas callers to co-create person-centered plans for care and expanded inter-organization collaborations. Initiatives that bolster local assistance funds' infrastructure and capacity will be needed as the abortion access landscape becomes further restricted and complex.
Collapse
Affiliation(s)
- Kari White
- Department of Sociology, Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas, USA
| | - Ophra Leyser-Whalen
- Department of Sociology and Anthropology, University of Texas at El Paso, El Paso, Texas, USA
| | - Brooke Whitfield
- Department of Sociology, University of Texas at Austin, Austin, Texas, USA
| | | | | | | | - Bhavik Kumar
- Planned Parenthood Gulf Coast, Houston, Texas, USA
| | - Ghazaleh Moayedi
- Pegasus Health Justice Center, Texas Equal Access Fund, Dallas, Texas, USA
| |
Collapse
|
11
|
JACQUES L, VALLEY T, ZHAO S, LANDS M, RIVERA N, HIGGINS JA. "I'm going to be forced to have a baby": A study of COVID-19 abortion experiences on Reddit. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2023; 55:86-93. [PMID: 37167095 PMCID: PMC10864016 DOI: 10.1363/psrh.12225] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
INTRODUCTION The initial stages of the COVID-19 pandemic affected abortion care in the United States (US) in myriad ways. While research has documented systems-level pandemic-related impacts on abortion access and care delivery little information exists about the experiences of abortion seekers during this period. We sought to document the effects of COVID-19 pandemic restrictions US abortion seekers by analyzing posts on Reddit, a popular social media website. METHODS We compiled and coded 528 anonymous posts on the abortion subreddit from 3/20/2020 to 4/12/2020 and applied inductive qualitative analytic techniques to identify themes. RESULTS We identified four primary themes. First, posters reported several COVID-19-related barriers to abortion services: reduced in-person access due to clinic closures, mail delivery delays of abortion medications, and pandemic-related financial barriers to both self-managed and in-clinic abortion. The second theme encompassed quarantine-driven privacy challenges, primarily challenges with concealing an abortion from household members. Third, posters detailed how the pandemic constrained their pregnancy decision making, including time pressure from impending clinic closures. Finally, posters reported COVID-19-related changes to service delivery that negatively affected their abortion experiences, for example being unable to bring a support person into the clinic due to pandemic visitor restrictions. DISCUSSION This analysis of real-time social media posts reveals multiple ways that the COVID-19 pandemic limited abortion access in the US and affected abortion seekers' decisions and experiences. Findings shed light on the consequences of sudden changes, whether pandemic or policy related, on abortion service delivery.
Collapse
Affiliation(s)
- Laura JACQUES
- Department of Obstetrics and Gynecology, University of Wisconsin-Madison, 1010 Mound St, Madison, WI 53715, USA
- Collaborative for Reproductive Equity (CORE), University of Wisconsin-Madison, Medical Sciences Center 4245, 1300 University Avenue, Madison WI 53706
| | - Taryn VALLEY
- Department of Obstetrics and Gynecology, University of Wisconsin-Madison, 1010 Mound St, Madison, WI 53715, USA
- Collaborative for Reproductive Equity (CORE), University of Wisconsin-Madison, Medical Sciences Center 4245, 1300 University Avenue, Madison WI 53706
- Department of Anthropology, University of Wisconsin-Madison, 1180 Observatory Dr, Madison, WI 53706
| | - Shimin ZHAO
- Department of Philosophy, University of Wisconsin-Madison, Helen C. White Hall, 600 N Park St #5185, Madison, WI 53706
| | - Madison LANDS
- Department of Obstetrics and Gynecology, University of Wisconsin-Madison, 1010 Mound St, Madison, WI 53715, USA
- Collaborative for Reproductive Equity (CORE), University of Wisconsin-Madison, Medical Sciences Center 4245, 1300 University Avenue, Madison WI 53706
| | - Natalie RIVERA
- Collaborative for Reproductive Equity (CORE), University of Wisconsin-Madison, Medical Sciences Center 4245, 1300 University Avenue, Madison WI 53706
- Department of Counseling Psychology, University of Wisconsin-Madison, School of Education, 1000 Bascom Mall, Madison, WI 53706
| | - Jenny A. HIGGINS
- Department of Obstetrics and Gynecology, University of Wisconsin-Madison, 1010 Mound St, Madison, WI 53715, USA
- Collaborative for Reproductive Equity (CORE), University of Wisconsin-Madison, Medical Sciences Center 4245, 1300 University Avenue, Madison WI 53706
| |
Collapse
|
12
|
Lands M, Carpenter E, Valley T, Jacques L, Higgins J. "Am I the Only One Who Feels Like This?": Needs Expressed Online by Abortion Seekers. SOCIAL WORK 2023; 68:103-111. [PMID: 36795036 PMCID: PMC10074479 DOI: 10.1093/sw/swad011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/13/2022] [Accepted: 05/12/2022] [Indexed: 06/18/2023]
Abstract
In the United States, abortion is safe and common, but highly stigmatized and frequently targeted by legislation that aims to restrict access. Numerous obstacles impede access to abortion care, including logistical barriers like cost and transportation, limited clinic availability, and state-mandated waiting periods. Accurate abortion information can also be hard to access. To overcome these barriers, many people seeking abortion turn to anonymous online forums, including Reddit, for information and support. Examining this community provides a unique perspective on the questions, thoughts, and needs of people considering or undergoing an abortion. The authors web scraped 250 posts from subreddits that contain abortion-related posts, then coded deidentified posts using a combined deductive/inductive approach. The authors identified a subset of these codes in which users were giving/seeking information and advice on Reddit, then engaged in a targeted analysis of the needs expressed in these posts. Three interconnected needs emerged: (1) need for information, (2) need for emotional support, and (3) need for community around the abortion experience. In this study map the authors reflected these needs onto key social work practice areas and competencies; taken alongside support from social work's governing bodies, this research suggests that social workers would be beneficial additions to the abortion care workforce.
Collapse
Affiliation(s)
- Madison Lands
- MSW, MPH, is research program manager, Collaborative for Reproductive Equity, Department of Obstetrics and Gynecology, University of Wisconsin-Madison, 1010 Mound Street, Madison, WI 75371, USA
| | - Emma Carpenter
- PhD, MSW, is postdoctoral fellow, Population Research Center, University of Texas at Austin, Austin, TX, USA
| | - Taryn Valley
- MA, is an MD-PhD student, Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Laura Jacques
- MD, is assistant professor, Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Jenny Higgins
- PhD, MPH, is professor, Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| |
Collapse
|
13
|
Morris N, Ehrenreich K, Gurazada T, Grossman D. Feasibility and Acceptability of At-Home Routine Pregnancy Testing in the United States: A Pilot Study. Womens Health Issues 2023; 33:258-265. [PMID: 36822914 DOI: 10.1016/j.whi.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 12/21/2022] [Accepted: 01/12/2023] [Indexed: 02/25/2023]
Abstract
OBJECTIVES We aimed to investigate the acceptability of regular self-testing among people with increased risk for delayed pregnancy recognition when provided with free at-home pregnancy tests and to explore the feasibility of this intervention among a larger sample. MATERIALS AND METHODS In 2019-2020, we recruited participants across the United States by using flyers posted online and in community settings and abortion clinics. We purposively sampled people with pregnancy capacity who were 18 to 24 years old, had irregular menses, or had a recent second-trimester abortion. Participants were mailed pregnancy tests and instructions. Participants received text message reminders to test monthly over a 3-month period and were asked to text back results. Participants also completed online surveys at baseline, after 1 month, and after 3 months. A purposive subsample of participants was selected to participate in semi-structured interviews. Interviews were analyzed using thematic analysis of interview guide topics and emergent themes. RESULTS 61 participants were enrolled. Fifty-four participants (90%) responded to the text reminders and 52 (85%) reported testing in all 3 months. Fifty-eight (95%) said tests were easy to use, 59 (97%) said the results were clear, and all participants found it convenient to text their results. Fourteen participants completed qualitative interviews. All described continuing to test after the study and indicated high acceptability for text reminders. Interviewees described convenience and cost as primary benefits for preferring at-home pregnancy testing. CONCLUSIONS Regular self-testing and texting results is feasible and acceptable to participants provided with free at-home urine pregnancy tests. These results can inform future studies designed to investigate the effect of regular self-testing on timing of pregnancy detection to facilitate early entry to prenatal care or early abortion.
Collapse
Affiliation(s)
- Natalie Morris
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland, California
| | - Katherine Ehrenreich
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland, California
| | - Tanvi Gurazada
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland, California
| | - Daniel Grossman
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland, California.
| |
Collapse
|
14
|
Bergman ME, Gaskins VA, Allen T, Cheung HK, Hebl M, King EB, Sinclair RR, Siuta RL, Wolfe C, Zelin AI. The Dobbs Decision and the Future of Occupational Health in the US. OCCUPATIONAL HEALTH SCIENCE 2023; 7:1-37. [PMID: 36843836 PMCID: PMC9940085 DOI: 10.1007/s41542-023-00143-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/30/2022] [Accepted: 01/02/2023] [Indexed: 02/25/2023]
Abstract
Access to abortion care has a profound impact on women's ability to participate in the workforce. In the US, restrictions on abortion care have waxed and waned over the years, including periods when abortion was broadly permitted across the nation for most pregnant people for a substantial proportion of pregnancy and times when restrictions varied across states, including states where abortion is banned for nearly all reasons. Additionally, access to abortion care has always been a reproductive justice issue, with some people more able to access this care than others even when it is structurally available. In June 2022, the US Supreme Court handed down the Dobbs v. Jackson Women's Health Organization, returning to states the ability to determine restrictions on abortion, including near-total bans on abortion. In this anthology, ten experts share their perspectives on what the Dobbs decision means for the future, how it will exacerbate existing, well-researched issues, and likely also create new challenges needing investigation. Some contributions are focused on research directions, some focus on implications for organizations, and most include both. All contributions share relevant occupational health literature and describe the effects of the Dobbs decision in context.
Collapse
Affiliation(s)
- Mindy E. Bergman
- grid.264756.40000 0004 4687 2082Texas A&M University, College Station, TX USA
| | | | - Tammy Allen
- grid.170693.a0000 0001 2353 285XUniversity of South Florida, Tampa, FL USA
| | - Ho Kwan Cheung
- grid.22072.350000 0004 1936 7697University of Calgary, Calgary, Alberta Canada
| | - Mikki Hebl
- grid.21940.3e0000 0004 1936 8278Rice University, Houston, TX USA
| | - Eden B. King
- grid.21940.3e0000 0004 1936 8278Rice University, Houston, TX USA
| | | | - Rose L. Siuta
- grid.264756.40000 0004 4687 2082Texas A&M University, College Station, TX USA
| | | | | |
Collapse
|
15
|
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.
Collapse
Affiliation(s)
- Ushma D Upadhyay
- Ushma D. Upadhyay , University of California San Francisco (UCSF), San Francisco, California
| | | | | | | | | |
Collapse
|