Roadblocks at every turn: What reproductive health experts say about barriers to legislative abortion advocacy

OBJECTIVES

Advocacy is an important part of the reproductive health care profession, but barriers to participating in the legislative process are not well understood. This study examines the barriers experts in reproductive health experience to testifying at state legislative committee hearings regarding abortion.

STUDY DESIGN

We conducted in-depth semistructured interviews with 40 experts in reproductive health, including obstetrician gynecologists (OBGYNs), midwives, pediatricians, nurses, primary care providers, and professional advocates. We analyzed the interview transcripts using an inductive coding process.

RESULTS

We identified four barriers to testifying at state legislative committee hearings regarding abortion. First, our interviewees described a tension between claiming expertise and stigma: those without direct experience in abortion care often felt too unqualified to testify, but representing oneself as an abortion provider came with stigma that made communicating with legislators difficult. Second, issues of power and identity informed interactions in committee chambers, as well as the structure of advocacy work more broadly. Third, institutional constraints shaped what experts could say and whether they could rely on their professional affiliations for support. Finally, fear of harassment and violence kept many of our interviewees from testifying, especially those who were active abortion providers.

CONCLUSIONS

These barriers appear unique to testifying on abortion and represent a complex web of hurdles that experts in reproductive health must navigate to participate in this part of the policymaking process.

IMPLICATIONS

Our findings suggest multiple strategies for improving the state of expert involvement in abortion policymaking, including expanding the pool of testifiers to include nonabortion providers and experts with a range of backgrounds, as well as supporting organizations that link experts to training and advocacy networks.

Expert participation in 25 years of Wisconsin abortion policymaking

OBJECTIVE

State-level abortion restrictions grew considerably in number over the last two decades. This study examines the scope of expert testimony given in legislative committee hearings at which these laws are first debated.

STUDY DESIGN

We gathered 265 testimonies given by experts at Wisconsin legislative committee hearings on 34 abortion bills from 1995-2019. We coded testimonies to identify testifiers' ideological leaning and source of expertise. We conducted descriptive analyses of testifiers' participation.

RESULTS

Experts with anti-abortion rights views testified more often than experts with pro-abortion rights views (2.1 vs 1.4 testimonies per expert). Experts with an activism background testified more often than experts in medicine (2.5 vs 1.3 testimonies per expert). Anti-abortion activist experts represented the largest proportion of testimonies (32%) but the smallest proportion of testifiers (16%). Pro-abortion rights medical experts gave the fewest testimonies (24%) relative to their proportion of testifiers (31%). The number of testimonies given by pro-abortion rights activist experts remained stable over the study period. Testimonies given by all other kinds of experts were more numerous in recent years.

CONCLUSIONS

The experts who testify most frequently tend to espouse anti-abortion views and have backgrounds in activism rather than healthcare. These repeat testifiers may have more opportunities to build relationships with legislators and thus influence policy. Anti-abortion rights activist experts' outsized role in legislative hearings, especially in recent years, should concern advocates of evidence-based reproductive health policy. Medical experts may be deterred from giving testimony by logistical or other structural barriers in the legislative process.

IMPLICATIONS

The family planning field should conduct more research on the role of experts in abortion policymaking. Future studies should examine testifiers in other states and identify barriers pro-abortion medical experts may face to testifying, as these experts are key for creating evidence-based abortion policy.

Federalism and bioethics

The absence of comprehensive federal oversight of human biotechnologies in the United States continues to stimulate academic discourse on the relative merits of European-style regulatory agencies as compared to the current, decentralized approach. Many American bioethicists support the latter, maintaining that the key features of federalism--policy experimentation and moral pluralism--allows for the efficient regulation of these complex and contentious issues. This paper examines state-level regulation of oocyte donation to assess claims regarding the superiority of this decentralized regulatory approach. Further, this paper introduces an additional element to this examination of state law, which concerns the degree to which the health and safety of key participants is addressed at the state level. This inquiry assesses one facet of fertility medicine and biomedical research law, oocyte donation, an analysis that can be used to inform the broader discourse regarding the regulation of human biotechnologies and bioethical issues by the states.