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Littell JH, Young S, Pigott TD, Biggs MA, Munk‐Olsen T, Steinberg JR. Abortion and mental health outcomes: A systematic review and meta-analysis. CAMPBELL SYSTEMATIC REVIEWS 2024; 20:e1410. [PMID: 38779333 PMCID: PMC11109527 DOI: 10.1002/cl2.1410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 04/17/2024] [Accepted: 04/23/2024] [Indexed: 05/25/2024]
Abstract
This is a protocol for a systematic review and meta-analysis of research on mental health outcomes of abortion. Does abortion increase the risk of adverse mental health outcomes? That is the central question for this review. Our review aims to inform policy and practice by locating, critically appraising, and synthesizing empirical evidence on associations between abortion and subsequent mental health outcomes. Given the controversies surrounding this topic and the complex social, political, legal, and ideological contexts in which research and reviews on abortion are conducted, it is especially important to conduct this systematic review and meta-analysis with comprehensive, rigorous, unbiased, and transparent methods. We will include a variety of study designs to enhance understanding of studies' methodological strengths and weaknesses and to identify potential explanations for conflicting results. We will follow open science principles, providing access to our methods, measures, and results, and making data available for re-analysis.
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Affiliation(s)
- Julia H. Littell
- Graduate School of Social Work and Social ResearchBryn Mawr CollegeBryn MawrPennsylvaniaUSA
| | - Sarah Young
- Hunt LibraryCarnegie Mellon UniversityPittsburghPennsylvaniaUSA
| | - Therese D. Pigott
- College of Education and Human DevelopmentGeorgia State UniversityAtlantaGeorgiaUSA
| | - M. Antonia Biggs
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, School of MedicineUniversity of California San FranciscoOaklandCaliforniaUSA
| | - Trine Munk‐Olsen
- Department of PsychiatryUniversity of Southern DenmarkOdenseDenmark
| | - Julia R. Steinberg
- Department of Family Science, School of Public HealthUniversity of MarylandCollege ParkMarylandUSA
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2
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McMann TJ, Haupt MR, Le N, Meurice ME, Li J, Cuomo RE, Mackey TK. Abortion pill marketing and sourcing on twitter following Dobbs v. Jackson supreme court ruling. EUR J CONTRACEP REPR 2024:1-6. [PMID: 38780176 DOI: 10.1080/13625187.2024.2354868] [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: 01/25/2024] [Accepted: 05/03/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE This study examines abortion-related discourse on Twitter (X) pre-and post-Dobbs v. Jackson ruling, which eliminated the constitutional right to abortion. STUDY DESIGN We used a custom data collection tool to collect tweets directly from Twitter using abortion-related keywords. We used the BERTopic language model and examined the top 30 retweeted and top 30 textually similar tweets from relevant topic clusters using an inductive coding approach. We also conducted statistical testing to assess potential associations between abortion themes. RESULTS 166,799 unique tweets were collected from December 2020-December 2022. 464 unique tweets were coded for abortion-related themes with 154 identified as relevant. Of these, 66 tweets marketed abortion pills, 17 tweets were identified as offering consultations, and 91 tweets were relevant to self-managed abortion. All marketing and consultation tweets were posted post-Dobbs decision and 7 (7.69%) of self-managed tweets were posted pre-Dobbs versus 84 (92.30%) posted post-Dobbs. A positive association was found between tweets offering a medical consultation with tweets marketing abortion pills and discussing self-managed abortion. CONCLUSION This study detected online marketing of abortion pills, consultations and discussions about self-managed abortion following the Dobbs v. Jackson ruling. These results provide more context to the type of abortion-related information that is available online.
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Affiliation(s)
- Tiana J McMann
- Global Health Program, Department of Anthropology, University of California San Diego, La Jolla, CA, USA
- Global Health Policy and Data Institute, San Diego, CA, USA
- S-3 Research, San Diego, CA, USA
| | - Michael R Haupt
- Global Health Policy and Data Institute, San Diego, CA, USA
- Department of Cognitive Science, University of California San Diego, San Diego, CA, USA
| | - Nicolette Le
- Global Health Program, Department of Anthropology, University of California San Diego, La Jolla, CA, USA
- Global Health Policy and Data Institute, San Diego, CA, USA
| | - Marielle E Meurice
- Division of Complex Family Planning, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, San Diego, CA, USA
| | | | - Raphael E Cuomo
- Global Health Policy and Data Institute, San Diego, CA, USA
- S-3 Research, San Diego, CA, USA
- Department of Anesthesiology, University of California San Diego - School of Medicine, San Diego, CA, USA
| | - Tim K Mackey
- Global Health Program, Department of Anthropology, University of California San Diego, La Jolla, CA, USA
- Global Health Policy and Data Institute, San Diego, CA, USA
- S-3 Research, San Diego, CA, USA
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3
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Starosta A, Harris J, Gariepy A, Pathy S, Cron J. Medication abortion for adolescents in the United States: Strengthening the role of pediatric primary care providers. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2024. [PMID: 38661101 DOI: 10.1111/psrh.12264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND Recent legal changes have led to mounting abortion restrictions in the United States (US), disproportionately impacting adolescents, who already face multifaceted barriers to abortion care. Informed by the framework of reproductive justice, adolescents who become pregnant deserve comprehensive, unbiased, and non-judgmental pregnancy options counseling, inclusive of all choices for pregnancy continuation and termination. Pediatric primary care providers are at the front lines of caring for adolescent patients' reproductive health needs and frequently diagnose pregnancy, provide pregnancy options counseling, and assist patients in accessing abortion care. They are uniquely poised to provide this care given their trusted, ongoing relationships with adolescent patients and their families, and their values of deep respect for adolescents' individuality and autonomy. METHODS In this commentary, we aim to describe the medical and legal landscape of adolescent abortion access in the US and provide recommendations to support pediatric primary care providers' involvement in abortion care. We focus on medication abortion, as the provision of medication abortion has the potential to encompass a broad group of clinicians, including pediatric primary care providers. RESULTS We discuss the importance of providing options counseling to adolescents within the reproductive justice framework, improving abortion education for pediatric providers, and expanding access to abortion care by supporting providers at an institutional level if they opt to provide medication abortions. CONCLUSION In light of the current legal landscape, the role of pediatric primary care providers in ensuring adolescent access to abortion care is ever more critical. Although many pediatric and adolescent providers already provide this important care, we, a team of obstetricians/gynecologists and adolescent medicine physicians, echo prior calls for improved training and institutional support for pediatric providers to counsel about and provide abortion-related care. We hope that highlighting the role of pediatric providers in this sphere will help center the needs of adolescent patients and help them fulfill their family planning goals.
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Affiliation(s)
- Anabel Starosta
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
| | - Julen Harris
- Department of Pediatrics, Weill Cornell Medical College, New York, New York, USA
| | - Aileen Gariepy
- Department of Obstetrics & Gynecology, Division of Complex Family Planning, Weill Cornell Medical College, New York, New York, USA
| | - Shefali Pathy
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
| | - Julia Cron
- Department of Obstetrics & Gynecology, Weill Cornell Medical College, New York, New York, USA
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Dutton-Kenny M, Ojanen-Goldsmith A, Dwyer E, Horner D, Prager SW. Supported at-home abortion: An exploratory study of methods, outcomes, and motivations of community-led abortion care in the United States and Canada. Contraception 2024; 132:110368. [PMID: 38232941 DOI: 10.1016/j.contraception.2024.110368] [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: 05/29/2022] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 01/19/2024]
Abstract
OBJECTIVES This an exploratory study aimed to describe methods and outcomes of comprehensive community-led abortion care in the United States and Canada. STUDY DESIGN This community-based participatory research study recruited community abortion providers from the United States and Canada through existing confidential networks. They participated through in-person and online collaboration to design and implement a data collection tool for abortion methods, outcomes, and motivations from clients. We implemented significant security measures to protect participant confidentiality. RESULTS Thirty community providers were recruited, five withdrew, and 12 provided data for 167 at-home abortions. Most abortions occurred between 6 and 10 weeks (104 [62%]). Abortions between 13 and 21 weeks represent 39 cases (23%). Misoprostol only was the most common method (n = 125 [75%]), followed by herbs alone (n = 12 [7%]) and aspiration (n = 12 [7%]). Complications were rare (n = 3 [1.8%]), with 163 complete abortions (98%). The primary motivation for seeking community-led abortion care was avoiding a clinic. CONCLUSIONS Community providers employed various abortion methods with safety and effectiveness profiles comparable to those reported for clinical and community-based abortion care. Clients wanting a different model of abortion care seek out community-led abortions, regardless of whether clinics are legal and accessible. IMPLICATIONS Community-led abortion is a viable choice for patients. Community providers should be recognized for their contributions to abortion access and high-quality, person-centered care. This study demonstrates a broader range of abortion providers and diverse options meeting the need for individualized abortion care.
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Affiliation(s)
| | | | - Erin Dwyer
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA, United States
| | | | - Sarah Ward Prager
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA, United States.
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5
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Narasimhan M, Hargreaves JR, Logie CH, Abdool-Karim Q, Aujla M, Hopkins J, Cover J, Sentumbwe-Mugisa O, Maleche A, Gilmore K. Self-care interventions for women's health and well-being. Nat Med 2024; 30:660-669. [PMID: 38454127 DOI: 10.1038/s41591-024-02844-8] [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] [Received: 11/17/2023] [Accepted: 01/31/2024] [Indexed: 03/09/2024]
Abstract
The human right to health is universal and non-exclusionary, supporting health in full, and for all. Despite advances in health systems globally, 3.6 billion people lack access to essential health services. Women and girls are disadvantaged when it comes to benefiting from quality health services, owing to social norms, unequal power in relationships, lack of consideration beyond their reproductive roles and poverty. Self-care interventions, including medicines and diagnostics, which offer an additional option to facility-based care, can improve the autonomy and agency of women in managing their own health. However, tackling challenges such as stigma is essential to avoid scenarios in which self-care interventions provide more choice for those who already benefit from access to quality healthcare, and leave behind those with the greatest need. This Perspective explores the opportunities that self-care interventions offer to advance the health and well-being of women with an approach grounded in human rights, gender equality and equity.
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Affiliation(s)
- Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, including the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland.
| | - James R Hargreaves
- Center for Evaluation, London School of Hygiene and Tropical Medicine, London, UK
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | | | - Mandip Aujla
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | | | - Jane Cover
- Sexual and Reproductive Health Program, PATH, Seattle, WA, USA
| | | | - Allan Maleche
- Kenya Legal & Ethical Issues Network on HIV and AIDS (KELIN), Nairobi, Kenya
| | - Kate Gilmore
- Department of International Development, London School of Economics and Political Science, London, UK
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McMahon HV, McMahon BD. Automating untruths: ChatGPT, self-managed medication abortion, and the threat of misinformation in a post- Roe world. Front Digit Health 2024; 6:1287186. [PMID: 38419805 PMCID: PMC10900507 DOI: 10.3389/fdgth.2024.1287186] [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: 09/01/2023] [Accepted: 01/26/2024] [Indexed: 03/02/2024] Open
Abstract
Background ChatGPT is a generative artificial intelligence chatbot that uses natural language processing to understand and execute prompts in a human-like manner. While the chatbot has become popular as a source of information among the public, experts have expressed concerns about the number of false and misleading statements made by ChatGPT. Many people search online for information about self-managed medication abortion, which has become even more common following the overturning of Roe v. Wade. It is likely that ChatGPT is also being used as a source of this information; however, little is known about its accuracy. Objective To assess the accuracy of ChatGPT responses to common questions regarding self-managed abortion safety and the process of using abortion pills. Methods We prompted ChatGPT with 65 questions about self-managed medication abortion, which produced approximately 11,000 words of text. We qualitatively coded all data in MAXQDA and performed thematic analysis. Results ChatGPT responses correctly described clinician-managed medication abortion as both safe and effective. In contrast, self-managed medication abortion was inaccurately described as dangerous and associated with an increase in the risk of complications, which was attributed to the lack of clinician supervision. Conclusion ChatGPT repeatedly provided responses that overstated the risk of complications associated with self-managed medication abortion in ways that directly contradict the expansive body of evidence demonstrating that self-managed medication abortion is both safe and effective. The chatbot's tendency to perpetuate health misinformation and associated stigma regarding self-managed medication abortions poses a threat to public health and reproductive autonomy.
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Affiliation(s)
- Hayley V. McMahon
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA, United States
- The Center forReproductive Health Research in the Southeast, Emory University Rollins School of Public Health, Atlanta, GA, United States
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Broussard K. Strategic (Non)Disclosure: Activation and Avoidance of Social Ties among Women Seeking Abortion. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2024:221465231215783. [PMID: 38229506 DOI: 10.1177/00221465231215783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
The increased politicization of sexual and reproductive health has created barriers to medically necessary care. In absence of formal health care, social ties become critical sources of information and resources, yet the disclosure of stigmatized health needs carries significant risk. How do people navigate the risks and benefits of disclosure when seeking care for stigmatized needs? Drawing on original survey data (N = 153) and in-depth interviews (N = 55) with women who attempted a self-managed abortion, I first describe the distinct roles of weak and strong ties in women's health-seeking experiences. I then demonstrate how both partial disclosure and nondisclosure are critical tools for obtaining information, resources, and emotional support during periods of health-seeking. Findings advance understanding of disclosure as a continuum that can be strategically wielded by people with stigmatized needs to confront and evade stigma and surveillance from their networks, the state, and the formal health care system.
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8
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Biggs MA, Becker A, Schroeder R, Kaller S, Scott K, Grossman D, Raifman S, Ralph L. Support for criminalization of self-managed abortion (SMA): A national representative survey. Soc Sci Med 2024; 340:116433. [PMID: 38039765 DOI: 10.1016/j.socscimed.2023.116433] [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: 03/17/2023] [Revised: 10/24/2023] [Accepted: 11/12/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE Since the U.S. Supreme Court eliminated the federal right to abortion, there is a heightened need to understand public opinion about the criminalization of people who attempt to end their pregnancies outside the formal healthcare setting, referred to as self-managed abortion (SMA). We assessed U.S. attitudes about whether three forms of SMA should be legal, reported or punished: 1) using abortion pills obtained outside the healthcare system, 2) using other medications, drugs, herbs, or by drinking alcohol, and 3) using traumatic methods (inserting an object in their body or hitting their stomach). METHODS From December 2021 to January 2022, we administered a national probability-based online survey to English- and Spanish-speaking people assigned female (AFAB, ages 15-49) or male at birth (AMAB, ages 18-49) regarding their attitudes about criminalizing SMA, using Ipsos' KnowledgePanel. We estimated weighted proportions and conducted multivariable regression analyses to identify characteristics associated with support for SMA legality and punishment (reporting to authorities, paying a fine or going to jail). RESULTS A total of 7,016 AFAB and 360 AMAB completed the survey. People were less likely (p < .05) to agree that SMA using abortion pills should be illegal (34% of AFAB and 43% of AMAB) than other forms of SMA (36-48%), although over one-fifth were unsure (AFAB, 20-23% and AMAB, 24-27%). People were less likely to agree SMA using abortion pills should be criminalized than SMA using other drugs, medications, herbs, alcohol or by using traumatic methods. In multivariable analyses, AMAB and Christian religion were associated with agreeing that SMA using abortion pills should be illegal; people who identified as Hispanic/Latinx ethnicity and experienced medical mistreatment were less likely to agree SMA with medication abortion pills should be illegal. CONCLUSIONS Public support for criminalizing SMA is complex and varied by SMA method and form of punishment.
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Affiliation(s)
- M Antonia Biggs
- 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, CA, 94612, USA.
| | - Andréa Becker
- 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, CA, 94612, USA; Department of Sociology, Hunter College, City University of New York, 695 Park Ave NY, NY, 10065, USA
| | - Rosalyn Schroeder
- 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, CA, 94612, USA
| | - Shelly Kaller
- 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, CA, 94612, USA
| | - Karen Scott
- 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, CA, 94612, USA; Birthing Cultural Rigor, LLC, Nashville, TN, 37209, USA
| | - 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, CA, 94612, USA
| | - Sarah Raifman
- 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, CA, 94612, USA
| | - Lauren Ralph
- 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, CA, 94612, USA
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Fleurant E, McCloskey L. Medication Abortion: A Comprehensive Review. Clin Obstet Gynecol 2023; 66:706-724. [PMID: 37910067 DOI: 10.1097/grf.0000000000000812] [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: 11/03/2023]
Abstract
This chapter provides an overview of evidence-based guidelines for medication abortion in the first trimester. We discuss regimens, both FDA-approved and other clinical-based protocols, and will briefly discuss novel self-managed abortion techniques taking place outside the formal health care system. Overview of patient counseling and pain management are presented with care to include guidance on "no touch" regimens that have proven both feasible and effective. We hope that this comprehensive review helps the health care community make strides to increase access to abortion in a time when reproductive health care is continuously restricted.
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Affiliation(s)
- Erin Fleurant
- Department of Obstetrics and Gynecology, Northwestern McGaw Medical Center, Chicago, Illinois
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10
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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.
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Affiliation(s)
- Christina Jung
- Department of Obstetrics and Gynecology, NYU Grossman School of Medicine, New York, New York
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11
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Chen TX, Hamachi A, Soon R, Natavio M. Roots, Leaves, and Flowers: A Narrative Review of Herbs and Botanicals Used for Self-Managed Abortion in Asia and the Pacific. J Midwifery Womens Health 2023; 68:710-718. [PMID: 37668006 DOI: 10.1111/jmwh.13561] [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] [Indexed: 09/06/2023]
Abstract
Abortion has existed throughout history, often outside of formal health care systems. This type of care, now called self-managed abortion, has historically been achieved in part through botanicals and traditional medicines. Their use continues into the modern day, especially in Asia, Hawai'i, and other Pacific Islands, where indigenous medicine traditions practice alongside allopathic medicine. Many of these botanicals, such as papaya leaves, hibiscus flowers, and young kī, and traditional medicines, such as tianhuafen, yuanhua, and Shenghua Decoction, have undergone scientific and clinical investigation of their potential abortifacient and antifertility action. The incidence of self-managed abortion with such abortifacients in countries with severe abortion restrictions are only estimates, leading to the possibility that legal rulings and societal pressures may cause underreporting. The Asian American, Native Hawaiian, and Pacific Islander communities in the United States also suffer from a lack of abortion access in addition to unique health disparities and barriers to reproductive health care. As difficulties in abortion access increases due to the Supreme Court decision in Dobbs v. Jackson Women's Health Organization, some may seek or even prefer self-managed abortion through traditional methods that have been passed down in their communities. Midwives and other health care providers may then be contacted during this process. This narrative review provides an overview of the literature on the use of botanicals, herbs, and traditional medicines used for self-managed abortion, specifically in Asia, Hawai‧i, and other Pacific Islands. Their implications for practice for providers in the United States and further opportunities for research are also presented.
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Affiliation(s)
- Tracy X Chen
- Division of Complex Family Planning, Department of Obstetrics and Gynecology, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - April Hamachi
- John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Reni Soon
- Division of Complex Family Planning, Department of Obstetrics and Gynecology, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Melissa Natavio
- Division of Complex Family Planning, Department of Obstetrics and Gynecology, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
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12
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Kapp N, Mao B, Menzel J, Eckersberger E, Saphonn V, Rathavy T, Pearson E. A prospective, comparative study of clinical outcomes following clinic-based versus self-use of medical abortion. BMJ SEXUAL & REPRODUCTIVE HEALTH 2023; 49:300-307. [PMID: 36894309 PMCID: PMC10579469 DOI: 10.1136/bmjsrh-2022-201722] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 02/12/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND To determine whether clinical outcomes differ among women accessing a combined medical abortion regimen from a health clinic when compared with those accessing it from a pharmacy. METHODS We conducted a multicentre, prospective, comparative, non-inferiority study of participants aged ≥15 years seeking medical abortion from five clinics and five adjacent pharmacy clusters in three provinces of Cambodia. Participants were recruited in-person at the point of purchase (clinic or pharmacy). Follow-up for self-reported pill use, acceptability, and clinical outcomes occurred by telephone at days 10 and 30 after mifepristone administration. RESULTS Over 10 months, we enrolled 2083 women with 1847 providing outcome data: 937 from clinics and 910 from pharmacies. Most were early in their pregnancy (mean gestational age of 6.3 and 6.1 weeks, respectively) and almost all took the pills correctly (98% and 96%,). Additional treatment needed to complete the abortion was non-inferior for the pharmacy group (9.3%) compared with the clinic group (12.7%). More from the clinic group received additional care from a provider, such as antibiotics or diagnostics tests, than those from the pharmacy group (11.5% and 3.2%,), and one ectopic pregnancy (pharmacy group) was successfully treated. Most said they felt prepared for what happened after taking the pills (90.9% and 81.3%, respectively, p=0.273). CONCLUSIONS Self-use of a combined medical abortion product resulted in comparable clinical outcomes as use following a clinical visit, consistent with existing literature on its safety and efficacy. Registration and availability of medical abortion as an over-the-counter product would likely increase women's access to safe abortion.
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Affiliation(s)
| | - Bunsoth Mao
- University of Health Sciences, Phnom Penh, Cambodia
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Kramer A, Ti A, Travis L, Laboe A, Ochieng WO, Young MR. The impact of parental involvement laws on minors seeking abortion services: a systematic review. HEALTH AFFAIRS SCHOLAR 2023; 1:qxad045. [PMID: 38756747 PMCID: PMC10986272 DOI: 10.1093/haschl/qxad045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/10/2023] [Accepted: 09/15/2023] [Indexed: 05/18/2024]
Abstract
On June 24, 2022, the US Supreme Court overturned the constitutional right to abortion in Dobbs v Jackson Women's Health Organization. Minors are a vulnerable population with a high risk of unintended pregnancy who are likely to be disproportionately affected by abortion restrictions. Examining the impact of historical abortion restrictions in minors may provide insight into the anticipated effects of the Dobbs decision. This study is a systematic review examining the impact of parental involvement (PI) laws on minors seeking abortion services. Our review suggests an association between PI laws and decreased abortion rates. Parental involvement laws also may increase pregnancy and birth rates and out-of-state travel for abortion procedures and lead to later abortions, although effects appear to be heterogenous.
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Affiliation(s)
- Alisha Kramer
- Department of Gynecology and Obstetrics, Emory University School of Medicine,Atlanta, GA 30322, United States
| | - Angeline Ti
- Family Medicine, Wellstar Hospital,Morrow, GA 30260, United States
| | - Lisa Travis
- Woodruff Health Sciences Center Library, Emory University,Atlanta, GA 30322, United States
| | - Adrienne Laboe
- Department of Obstetrics and Gynecology, Madigan Army Medical Center, Joint Base Lewis-McChord, WA 98431, United States
| | | | - Marisa R Young
- Department of Gynecology and Obstetrics, Emory University School of Medicine,Atlanta, GA 30322, United States
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Flores L, Kelani Z, Chandwani C, Young SD. Internet Searches for Self-Managed Abortion After Roe v Wade Overturned. JAMA Surg 2023; 158:976-977. [PMID: 37405767 PMCID: PMC10323758 DOI: 10.1001/jamasurg.2023.2410] [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] [Received: 01/05/2023] [Accepted: 04/23/2023] [Indexed: 07/06/2023]
Abstract
This cross-sectional study used search data from Google Trends to estimate public interest in self-managed abortion.
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Affiliation(s)
- Lidia Flores
- Department of Informatics, University of California, Irvine, Irvine
| | - Zeyad Kelani
- Department of Informatics, University of California, Irvine, Irvine
| | - Carrie Chandwani
- Department of Emergency Medicine, University of California, Irvine
| | - Sean D. Young
- Department of Informatics, University of California, Irvine, Irvine
- Department of Emergency Medicine, University of California, Irvine
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15
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Sangtani A, Owens L, Broome DT, Gogineni P, Herman WH, Harris LH, Oshman L. The Impact of New and Renewed Restrictive State Abortion Laws on Pregnancy-Capable People with Diabetes. Curr Diab Rep 2023; 23:175-184. [PMID: 37213059 DOI: 10.1007/s11892-023-01512-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 05/23/2023]
Abstract
PURPOSE OF REVIEW When the Supreme Court handed down its decision in Dobbs v Jackson Women's Health Organization in June 2022, the constitutional right to abortion was no longer protected by Roe v Wade. Fifteen states now have total or near-total bans on abortion care or no clinics providing abortion services. We review how these restrictions affect the medical care of people with pregestational diabetes. RECENT FINDINGS Of the ten states with the highest percent of adult women living with diabetes, eight currently have complete or 6-week abortion bans. People with diabetes are at high risk of diabetes-related pregnancy complications and pregnancy-related diabetes complications and are disproportionately burdened by abortion bans. Abortion is an essential part of comprehensive, evidence-based diabetes care, yet no medical society has published guidelines on pregestational diabetes that explicitly discuss the importance and role of safe abortion care. Medical societies enacting standards for diabetes care and clinicians providing diabetes care must advocate for access to abortion to reduce pregnancy-related morbidity and mortality for pregnant people with diabetes.
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Affiliation(s)
- Ajleeta Sangtani
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA.
| | - Lauren Owens
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - David T Broome
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, USA
| | - Preethi Gogineni
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, USA
| | - William H Herman
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, USA
| | - Lisa H Harris
- Department of Obstetrics and Gynecology and Department of Women's and Gender Studies, University of Michigan, Ann Arbor, MI, USA
| | - Lauren Oshman
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
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16
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Karlin J, Joffe C. Self-Sourced Medication Abortion, Physician Authority, and the Contradictions of Abortion Care. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2023; 48:603-627. [PMID: 36693174 DOI: 10.1215/03616878-10449932] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The growing acknowledgment of the phenomenon of individuals terminating their pregnancies by obtaining the medications necessary for an abortion-which this article refers to as "self-sourced medication abortion" (SSMA)-has shed light on the current contradictions in the world of abortion provision. This article offers a brief historical overview of the relationship between abortion provision and mainstream medicine, pointing to the factors that have led to the marginalization of abortion care. It then discusses interviews with 40 physicians who provide abortions about their perspectives on SSMA, and it explores how this group responds to the contradictions presented by SSMA. In doing so, it interrogates the changing meaning of "physician authority" among this subset of physicians. The authors suggest that these interviewees represent an emergent sensibility among this generation of abortion physicians, a sensibility strongly tied to a commitment to social justice.
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17
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Feng C, Fay KE, Burns MM. Toxicities of herbal abortifacients. Am J Emerg Med 2023; 68:42-46. [PMID: 36924751 PMCID: PMC10192026 DOI: 10.1016/j.ajem.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 03/01/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND In the post-Roe era, barriers to facility-based abortions may lead to an increased incidence of self-managed abortions. While misoprostol-based medication abortions have significant literature supporting its safety profile, there is a knowledge deficit within the medical community regarding the toxicities of commonly used herbal abortifacients. METHODS This is a narrative review, based on a MEDLINE and HOLLIS database search, of self-managed abortion methods with herbal abortifacients and their associated toxicities. RESULTS Common herbal abortifacients with significant morbidity and mortality implications include pennyroyal, blue cohosh, rue, and quinine. Other commonly reported abortifacients considered to be less toxic also are discussed in brief. Special considerations for hepatic, cardiac, renal, and hematologic toxicities are important in patients with significant exposures to these herbal substances. CONCLUSION There is an anticipated increase in the utility of herbal xenobiotics for self-managed abortions with post-Roe restrictions to standard mifepristone-misoprostol protocols. Frontline providers should be aware of the associated toxicities and have special considerations when treating a poisoned patient in this population.
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Affiliation(s)
- Chris Feng
- Harvard Medical Toxicology, Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA.
| | - Kathryn E Fay
- Department of Obstetrics, Gynecology and Reproductive Medicine, Harvard Medical School, Boston, MA, USA
| | - Michele M Burns
- Harvard Medical Toxicology, Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA
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18
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Roberts SCM, Zaugg C, Grossman D. Health care provider reporting practices related to self-managed abortion. BMC Womens Health 2023; 23:136. [PMID: 36973776 PMCID: PMC10045784 DOI: 10.1186/s12905-023-02266-7] [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: 11/16/2022] [Accepted: 03/08/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Health care providers reporting patients to government authorities is a main way people attempting self-managed abortion (SMA) become exposed to legal risks. Little is known about health care provider decision-making regarding SMA reporting. METHODS We conducted semi-structured interviews with 37 clinicians who provided care in hospital-based obstetrics or emergency departments (13 obstetricians/gynecologists, two advance practice registered nurses providing obstetrics care, 12 emergency medicine physicians, and 10 family medicine physicians) throughout the United States. The interview guide asked participants to describe one or more cases of caring for a patient who may have attempted SMA and about related reporting decisions. We coded responses to answer two questions: What comes to mind for health care providers when asked to think about experiences caring for a patient who may have attempted SMA? Based on health care provider experiences, how might people who providers suspect may have attempted SMA end up reported? RESULTS About half of participants had cared for someone who may have attempted SMA for that pregnancy. Only two mentioned SMA with misoprostol. Most participants described cases where they were unsure whether the patient had attempted to end their pregnancy on purpose. In most instances, participants mentioned that that the possibility of reporting never occurred to them nor came up. In some cases, participants described a reporting "adjacent" practice - e.g. beginning processes that could lead to substance use, domestic violence, or self-injury/suicide-related reports - or considered reporting related to a perceived need to report abortion complications. In two cases, hospital staff reported to the police and/or Child Protective Services related to the SMA attempt. These involved passing of a fetus after 20 weeks outside the hospital and a domestic violence incident. CONCLUSION Reporting patients who may have attempted SMA may occur via provider perception of a need to report abortion complications and fetal demises, particularly at later gestations, and other reporting requirements (e.g. substance use, domestic violence, child maltreatment, suicide/self-harm).
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Affiliation(s)
- Sarah C M Roberts
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA, 94612, USA.
| | - Claudia Zaugg
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA, 94612, USA
| | - Daniel Grossman
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA, 94612, USA
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19
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Verma N, Grossman D. Self-Managed Abortion in the United States. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2023; 12:70-75. [PMID: 37305376 PMCID: PMC9989574 DOI: 10.1007/s13669-023-00354-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2023] [Indexed: 03/09/2023]
Abstract
Purpose of Review This review aims to provide up-to-date information about self-managed abortion in the USA. Recent Findings Evidence indicates that there is growing demand for self-managed abortion in the USA as obstacles to facility-based care increase, especially since the Supreme Court overturned Roe v. Wade. Self-managed abortion with medications is safe and effective. Summary Based on a nationally representative survey, the lifetime prevalence of self-managed abortion in the USA in 2017 was estimated to be 7%. People experiencing barriers to abortion care, including people of color, people with lower incomes, people in states that have restrictive abortion laws, and those living farther from facilities providing abortion care are more likely to attempt self-managed abortion. While people may use a range of methods to self-manage abortion, there is growing use of safe and effective medications, including mifepristone used together with misoprostol and misoprostol used alone; use of traumatic and dangerous methods is rare. While many people attempt to self-manage their abortion because of barriers to facility-based care, others have a preference for self-care because it is convenient, accessible, and private. While the medical risks of self-managed abortion may be few, the legal risks may be significant. Sixty-one people have been criminally investigated or arrested between 2000 and 2020 for allegedly self-managing their abortion or helping someone else do so. Clinicians play an important role in providing evidence-based information and care to patients considering or attempting self-managed abortion, as well as minimizing legal risks.
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Affiliation(s)
- Nisha Verma
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA USA
| | - Daniel Grossman
- Advancing New Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco (UCSF), 1330 Broadway, Suite 1100, Oakland, CA 94612 USA
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20
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Fay KE, Alemu H, Perritt J. Self-managed abortion: Toxic legislation, non-toxic medication. Am J Emerg Med 2023; 64:193-194. [PMID: 36344352 PMCID: PMC9845147 DOI: 10.1016/j.ajem.2022.10.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Kathryn E. Fay
- Harvard Medical School, Department of Obstetrics, Gynecology, and Reproductive Biology, 25 Shattuck Street, Boston, MA 02115, United States of America
| | - Hanney Alemu
- Northeastern University, 360 Huntington Ave, Boston, MA 02115, United States of America
| | - Jamila Perritt
- Physicians for Reproductive Health, 1430 Broadway, Suite 1614, New York, NY 10018, United States of America
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21
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Ye P, Mazer-Amirshahi M. In reply. Am J Emerg Med 2023; 64:191-192. [PMID: 36336536 DOI: 10.1016/j.ajem.2022.10.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Peggy Ye
- Georgetown University School of Medicine, Washington, DC, United States of America; Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Maryann Mazer-Amirshahi
- Georgetown University School of Medicine, Washington, DC, United States of America; Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC, United States of America.
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22
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Beshar I, Liu SM, Shaw KA, Henkel A. Discovery of an Ectopic Pregnancy after Attempted Self-Managed Abortion. N Engl J Med 2023; 388:278-279. [PMID: 36652361 DOI: 10.1056/nejmc2214213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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23
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Frye LJ, Winikoff B. Abortion bans and their impacts: A view from the United States. Cell Rep Med 2023; 4:100905. [PMID: 36652914 PMCID: PMC9873925 DOI: 10.1016/j.xcrm.2022.100905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
A retrospective study of abortion facilities in and around Texas by White et al.1 and a spatial analysis by Rader et al.2 are combined to illustrate the detrimental effects of abortion bans enacted in the United States.
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24
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Bowler S, Vallury K, Sofija E. Understanding the experiences and needs of LGBTIQA+ individuals when accessing abortion care and pregnancy options counselling: a scoping review. BMJ SEXUAL & REPRODUCTIVE HEALTH 2023:bmjsrh-2022-201692. [PMID: 36635070 DOI: 10.1136/bmjsrh-2022-201692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/28/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Safe, accessible, and inclusive abortion care and pregnancy options counselling are essential components of sexual and reproductive health and rights. Research has documented LGBTIQA+ people are as likely, or more than likely, as the general population to experience an abortion in their lifetime yet face significant barriers to accessing abortion and related care, which undermines well-being. AIMS The present study undertakes a scoping review of research on the needs and experiences of the LGBTIQA+ population (representing lesbian, gay, bisexual, transgender, gender diverse, intersex, queer, asexual, and questioning) when accessing abortion care, pregnancy options, and post-abortion counselling to support improved understanding of pregnant people's preferences, needs, and experiences. METHODS The reporting of this scoping review is guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension of Scoping Reviews (PRISMA-ScR). Academic databases were searched using terms relating to gender identity and sexuality, abortion, pregnancy options, and post-abortion counselling to identify peer reviewed papers published in English. Seven publications were included in the review that described experiences of LGBTIQA+ people accessing abortion-related care. RESULTS The included studies were predominantly conducted in the USA using quantitative and qualitative research designs. Thematic analysis highlighted participants' experiences of discrimination and exclusion in healthcare settings, healthcare avoidance, unsafe abortion, non-disclosure to providers, and poor health outcomes for LGBTIQA+ people. CONCLUSIONS Gender-inclusive services and training for health providers is necessary to provide safe and accessible abortion care and overcome generations of mistrust held by the LGBTIQA+ community. Research into the needs of LGBTIQA+ people when accessing pregnancy options counselling is critically needed.
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Affiliation(s)
- Sally Bowler
- School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia
| | - Kari Vallury
- Children By Choice, Brisbane, Queensland, Australia
| | - Ernesta Sofija
- School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia
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25
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Keegan G, Francis M, Chalmers K, Hoofnagle M, Noory M, Essig R, Hoefer L, Bhardwaj N, Kaufman E, Crandall ML, Zaidi M, Koch V, McLaren H, Henry M, Dorsey C, Zakrison T, Chor J. Trauma of abortion restrictions and forced pregnancy: urgent implications for acute care surgeons. Trauma Surg Acute Care Open 2023; 8:e001067. [PMID: 36744294 PMCID: PMC9896239 DOI: 10.1136/tsaco-2022-001067] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 12/02/2022] [Indexed: 02/03/2023] Open
Abstract
In the aftermath of the Supreme Court's Dobbs vs. Jackson Women's Health decision, acute care surgeons face an increased likelihood of seeing patients with complications from both self-managed abortions and forced pregnancy in underserved areas of reproductive and maternity care throughout the USA. Acute care surgeons have an ethical and legal duty to provide care to these patients, especially in obstetrics and gynecology deserts, which already exist in much of the country and are likely to be exacerbated by legislation banning abortion. Structural inequities lead to an over-representation of poor individuals and people of color among patients seeking abortion care, and it is imperative to make central the fact that people of color who can become pregnant will be disproportionately affected by this legislation in every respect. Acute care surgeons must take action to become aware of and trained to treat both the direct clinical complications and the extragestational consequences of reproductive injustice, while also using their collective voices to reaffirm the right to abortion as essential healthcare in the USA.
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Affiliation(s)
- Grace Keegan
- Pritzker School of Medicine, University of Chicago Biological Sciences Division, Chicago, Illinois, USA
| | - Myles Francis
- Crown Family School of Social Work, Policy, and Practice, University of Chicago, Chicago, IL, USA
| | - Kristen Chalmers
- Pritzker School of Medicine, University of Chicago Biological Sciences Division, Chicago, Illinois, USA
| | - Mark Hoofnagle
- Surgery, Washington University in St Louis, St Louis, Missouri, USA
| | - Mary Noory
- Surgery, University of Chicago Biological Sciences Division, Chicago, Illinois, USA
| | - Rachael Essig
- Surgery, Georgetown University, Washington, District of Columbia, USA
| | - Lea Hoefer
- Surgery, University of Chicago Biological Sciences Division, Chicago, Illinois, USA
| | - Neha Bhardwaj
- Obstetrics and Gynecology, University of Chicago Biological Sciences Division, Chicago, Illinois, USA
| | - Elinore Kaufman
- Trauma and Surgical Critical Care, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Marie L Crandall
- Surgery, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida, USA
| | | | - Valerie Koch
- Pritzker School of Medicine, University of Chicago Biological Sciences Division, Chicago, Illinois, USA
| | - Hillary McLaren
- Obstetrics and Gynecology, University of Chicago Biological Sciences Division, Chicago, Illinois, USA
| | - Marion Henry
- Pediatric Surgery, University of Chicago Biological Sciences Division, Chicago, Illinois, USA
| | - Chelsea Dorsey
- Surgery, University of Chicago Biological Sciences Division, Chicago, Illinois, USA
| | - Tanya Zakrison
- Surgery, University of Chicago Biological Sciences Division, Chicago, Illinois, USA
| | - Julie Chor
- Obstetrics and Gynecology, University of Chicago Biological Sciences Division, Chicago, Illinois, USA
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26
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Jacobs MG, Boing AC. Travel as a barrier to abortion provided by law access. Brazil, 2010-2019. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2022. [DOI: 10.1590/1806-9304202200040007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Abstract Objectives: to analyze abortions provided by law (APL) carried out in Brazil between 2010 and 2019 regarding the need for travel of users, as well as the expenditure of time and money on these trips. Methods: descriptive study of records of outpatient care and hospitalizations for APL between 2010 and 2019. The municipal provision and the inter-municipal flows for the realization of the APL, the availability of public transportation for this travel, as well as its cost and time, were identified. Results: 2.6% of Brazilian municipalities had a sustained provision of APL between 2010 and 2019. Of the 15,889 APL performed, 14.8% occurred in municipalities other than those where the user lived. The smaller the population size of the municipality of residence, the higher the percentage of the need for travel. Of these inter-municipal trips, 16.0% had regular round-trip links by public transport. The total travel time ranged from 26 minutes to 4 and a half days, and the cost from R$2.70 to R$1,218.06; the highest medians were among residents of the Midwest region. Conclusions: the concentration of services, the deficiency of inter-municipal public transport, and the expenditure on travel to access the APL are barriers to users that need the health service, demanding public policies to overcome them.
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27
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Karlin J, Hodge CC. Intimacy, Anonymity, and "Care with Nothing in the Way" on an Abortion Hotline. Cult Med Psychiatry 2022:10.1007/s11013-022-09810-4. [PMID: 36441388 PMCID: PMC9707088 DOI: 10.1007/s11013-022-09810-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2022] [Indexed: 11/30/2022]
Abstract
This essay is an ethnographic account of a volunteer, anonymous hotline of physicians and advanced practice providers who offer medical advice and guidance to those who are taking medications on their own to end their pregnancies. Attending to the phenomenology of caring on the Hotline reveals a new form of medical expertise at play, which we call "care with nothing in the way." By operating outside the State's scrutiny of abortion provision, the Hotline offers its volunteers a way to practice abortion care that aligns with their professional and political commitments and that distances them from the direct harm they see caused by the political, financial, and bureaucratic constraints of their clinical work. By delineating the structure of this new regime of care, these providers call into question the notion of the "good doctor." They radically re-frame widely shared assumptions about the tenets of the ideal patient-doctor relationship and engender a new form of intimacy-one based, ironically, out of anonymity and not the familiarity that is often idealized in the caregiving relationship. We suggest the implications of "care with nothing in the way" are urgent, not only in the context of increasing hostility to abortion rights, but also for a culture of medicine plagued by physician burnout.
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Affiliation(s)
- Jennifer Karlin
- Department of Family and Community Medicine, University of California, 4860 Y Street, Suite 2320, DavisSacramento, CA 95817 USA
| | - Caroline C. Hodge
- University of California, San Francisco School of Medicine, Department of Anthropology, University of Pennsylvania, 3260 South Street, Philadelphia, PA 19104 USA
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28
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Grossman D, Verma N. Self-managed Abortion in the US. JAMA 2022; 328:1693-1694. [PMID: 36318121 DOI: 10.1001/jama.2022.19057] [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] [Indexed: 11/06/2022]
Abstract
This Viewpoint details how clinicians can treat patients who have self-managed an abortion without putting the patient at risk for criminalization.
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Affiliation(s)
- Daniel Grossman
- Advancing New Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco
| | - Nisha Verma
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
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29
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Ogbu-Nwobodo L, Shim RS, Vinson SY, Fitelson EM, Biggs MA, McLemore MR, Thomas M, Godzich M, Mangurian C. Mental Health Implications of Abortion Restrictions for Historically Marginalized Populations. N Engl J Med 2022; 387:1613-1617. [PMID: 36300980 DOI: 10.1056/nejmms2211124] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Lucy Ogbu-Nwobodo
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
| | - Ruth S Shim
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
| | - Sarah Y Vinson
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
| | - Elizabeth M Fitelson
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
| | - M Antonia Biggs
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
| | - Monica R McLemore
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
| | - Marilyn Thomas
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
| | - Micaela Godzich
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
| | - Christina Mangurian
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
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Protecting marginalized women's mental health in the post-Dobbs era. Proc Natl Acad Sci U S A 2022; 119:e2212012119. [PMID: 36149969 PMCID: PMC9546526 DOI: 10.1073/pnas.2212012119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Poliak A, Satybaldiyeva N, Strathdee SA, Leas EC, Rao R, Smith D, Ayers JW. Internet Searches for Abortion Medications Following the Leaked Supreme Court of the United States Draft Ruling. JAMA Intern Med 2022; 182:1002-1004. [PMID: 35767270 PMCID: PMC9244771 DOI: 10.1001/jamainternmed.2022.2998] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
This cross-sectional study evaluates whether internet searches for abortion medications increased following the leak of a draft Supreme Court of the United States ruling that would overturn the 1973 Roe v Wade decision.
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Affiliation(s)
- Adam Poliak
- Department of Computer Science, Bryn Mawr College, Bryn Mawr, Pennsylvania
| | - Nora Satybaldiyeva
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla.,Qualcomm Institute, University of California, San Diego, La Jolla
| | - Steffanie A Strathdee
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, La Jolla
| | - Eric C Leas
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla.,Qualcomm Institute, University of California, San Diego, La Jolla
| | - Ramesh Rao
- Qualcomm Institute, University of California, San Diego, La Jolla
| | - Davey Smith
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, La Jolla
| | - John W Ayers
- Qualcomm Institute, University of California, San Diego, La Jolla.,Division of Infectious Diseases and Global Public Health, University of California, San Diego, La Jolla
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Mifepristone: A Safe Method of Medical Abortion and Self-Managed Medical Abortion in the Post-Roe Era. Am J Ther 2022; 29:e534-e543. [PMID: 35994387 DOI: 10.1097/mjt.0000000000001559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The U.S. Supreme Court's Dobbs v. Jackson Women's Health Organization decision on June 24, 2022 effectively overturned federal constitutional protections for abortion that have existed since 1973 and returned jurisdiction to the states. Several states implemented abortion bans, some of which banned abortion after 6 weeks and others that permit abortion under limited exceptions, such as if the health or the life of the woman is in danger. Other states introduced bills that define life as beginning at fertilization. As a result of these new and proposed laws, the future availability of mifepristone, one of two drugs used for medical abortion in the United States, has become the topic of intense debate and speculation. AREAS OF UNCERTAINTY Although its safety and effectiveness has been confirmed by many studies, the use of mifepristone has been politicized regularly since its approval. Areas of future study include mifepristone for induction termination and fetal demise in the third trimester and the management of leiomyoma. DATA SOURCES PubMed, Society of Family Planning, American College of Obstetrician and Gynecologists, the World Health Organization. THERAPEUTIC ADVANCES The use of no-touch medical abortion, which entails providing a medical abortion via a telehealth platform without a screening ultrasound or bloodwork, expanded during the COVID-19 pandemic, and studies have confirmed its safety. With the Dobbs decision, legal abortion will be less accessible and, consequently, self-managed abortion with mifepristone and misoprostol will become more prevalent. CONCLUSIONS Mifepristone and misoprostol are extremely safe medications with many applications. In the current changing political climate, physicians and pregnancy-capable individuals must have access to these medications.
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Ralph L, Ehrenreich K, Kaller S, Biggs MA. A cross-sectional study examining consideration of self-managed abortion among people seeking facility-based care in the United States. Reprod Health 2022; 19:176. [PMID: 35962384 PMCID: PMC9375262 DOI: 10.1186/s12978-022-01486-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/22/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction With increasing restrictions on abortion across the United States, we sought to understand whether people seeking abortion would consider ending their pregnancy on their own if unable to access a facility-based abortion. Methods From January to June 2019, we surveyed patients seeking abortion at 4 facilities in 3 US states. We explored consideration of self-managed abortion (SMA) using responses to the question: “Would you consider ending this pregnancy on your own if you are unable to obtain care at a health care facility?” We used multivariable Poisson regression to assess associations between individual sociodemographic, pregnancy and care-seeking characteristics and prevalence of considering SMA. In bivariate Poisson models, we also explored whether consideration of SMA differed by specific obstacles to abortion care. Results One-third (34%) of 741 participants indicated they would definitely or probably consider ending the pregnancy on their own if unable to obtain care at a facility. Consideration of SMA was higher among those who reported no health insurance (adjusted prevalence ratio [aPR] = 1.66; 95% Confidence Interval [CI] 1.12–2.44), described the pregnancy as unintended (aPR = 1.53; 95% CI 1.08–2.16), were seeking abortion due to concerns about their own physical or mental health (aPR = 1.50, 95% CI 1.02, 2.20), or experienced obstacles that delayed their abortion care seeking (aPR = 2.26, 95% CI 1.49, 3.40). Compared to those who would not consider SMA, participants who would consider SMA expressed higher difficulty finding an abortion facility (35 vs. 27%, p = 0.019), figuring out how to get to the clinic (29 vs 21%, p = 0.021) and needing multiple clinic visits (23 vs 17%, p = 0.044). Conclusions. One in three people seeking facility-based abortion would consider SMA if unable to obtain abortion care at a facility. As abortion access becomes increasingly restricted in the US, SMA may become more common. Future research should continue to monitor people’s consideration and use of SMA and ensure that they have access to safe and effective methods.
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Affiliation(s)
- Lauren Ralph
- 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, 1330 Broadway Suite 1100, Oakland, CA, 94612, USA.
| | - 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, 1330 Broadway Suite 1100, Oakland, CA, 94612, USA
| | - Shelly Kaller
- 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, 1330 Broadway Suite 1100, Oakland, CA, 94612, USA
| | - M Antonia Biggs
- 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, 1330 Broadway Suite 1100, Oakland, CA, 94612, USA
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Affiliation(s)
- M Antonia Biggs
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
| | - Corinne Rocca
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
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Short SE, Zacher M. Women's Health: Population Patterns and Social Determinants. ANNUAL REVIEW OF SOCIOLOGY 2022; 48:277-298. [PMID: 38765764 PMCID: PMC11101199 DOI: 10.1146/annurev-soc-030320-034200] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Women's health, and what we know about it, are influenced by social factors. From the exclusion of women's bodies in medical research, to the silence and stigma of menstruation and menopause, to the racism reflected in maternal mortality, the relevance of social factors is paramount. After a brief history of research on women's health, we review selected patterns, trends, and inequalities in US women's health. These patterns reveal US women's poor and declining longevity relative to those in other high-income countries, gaps in knowledge about painful and debilitating conditions that affect millions of women, and deep inequalities that underscore the need to redress political and structural features of US society that enhance health for some and diminish it for others. We close by describing the challenges and opportunities for future research, and the promise of a social determinants of health approach for advancing a multilevel, intersectional, and biosocial understanding of women's health.
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Affiliation(s)
- Susan E Short
- Department of Sociology, Brown University, Providence, Rhode Island, USA
- Population Studies and Training Center, Brown University, Providence, Rhode Island, USA
| | - Meghan Zacher
- Population Studies and Training Center, Brown University, Providence, Rhode Island, USA
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Aiken AR, Romanova EP, Morber JR, Gomperts R. Safety and effectiveness of self-managed medication abortion provided using online telemedicine in the United States: A population based study. THE LANCET REGIONAL HEALTH - AMERICAS 2022; 10. [PMID: 35755080 PMCID: PMC9223776 DOI: 10.1016/j.lana.2022.100200] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background As access to clinical abortion care becomes increasingly restricted in the United States, the need for self-managed abortions (i.e. abortions taking place outside of the formal healthcare setting) may increase. We examine the safety, effectiveness, and acceptability of self-managed medication abortion provided using online telemedicine. Methods We retrospectively examined records of the outcomes of abortions provided by the sole online telemedicine service providing self-managed medication abortion in the U.S. We calculated the prevalence of successful medication abortion (the proportion who ended their pregnancy without surgical intervention); the prevalence of serious adverse events (the proportions who received intravenous antibiotics and blood transfusion); and assessed whether any deaths were reported to the service. We also examined the proportions who were satisfied and felt self-management was the right choice. Findings Between March 20th 2018 and March 20th 2019, abortion medications were mailed to 4,584 people and 3,186 (70%) provided follow-up information. Among these, 2,797 (88%) confirmed use of the medications and provided outcome information, while 389 (12%) confirmed non-use. Overall, 96.4% (95% CI 95.7% to 97.1%) of those who used the medications reported successfully ending their pregnancy without surgical intervention and 1.0% (CI 0.7%–1.5%) reported treatment for any serious adverse event. Among these, 0.6% (CI 0.4% to 1.0%) reported receiving a blood transfusion, and 0.5% (CI 0.3% to 0.9%) reported receiving intravenous antibiotics. No deaths were reported to the service by family, friends, the authorities, or the media. Among 2,268 who provided information about their experience, 98.4% were satisfied and 95.5% felt self-management was the right choice. Interpretation Self-managed medication abortion provided using online telemedicine can be highly effective with low rates of serious adverse events. In light of increasingly restricted access to in-clinic abortion in the U.S., it may offer a safe and effective option for those who cannot access clinical care. Funding The Society of Family Planning and The National Institutes of Health.
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Affiliation(s)
- Abigail R.A. Aiken
- LBJ School of Public Affairs, University of Texas at Austin, Austin, TX 78713, USA
- Corresponding author.
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Moseson H, Jayaweera R, Egwuatu I, Grosso B, Kristianingrum IA, Nmezi S, Zurbriggen R, Motana R, Bercu C, Carbone S, Gerdts C. Effectiveness of self-managed medication abortion with accompaniment support in Argentina and Nigeria (SAFE): a prospective, observational cohort study and non-inferiority analysis with historical controls. THE LANCET GLOBAL HEALTH 2022; 10:e105-e113. [PMID: 34801131 PMCID: PMC9359894 DOI: 10.1016/s2214-109x(21)00461-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 09/30/2021] [Accepted: 09/30/2021] [Indexed: 11/10/2022] Open
Abstract
Background Clinical trials have established the high effectiveness and safety of medication abortion in clinical settings. However, barriers to clinical abortion care have shifted most medication abortion use to out-of-clinic settings, especially in the context of the COVID-19 pandemic. Given this shift, we aimed to estimate the effectiveness of self-managed medication abortion (medication abortion without clinical support), and to compare it to effectiveness of clinician-managed medication abortion. Methods For this prospective, observational cohort study, we recruited callers from two safe abortion accompaniment groups in Argentina and Nigeria who requested information on self-managed medication abortion. Before using one of two medication regimens (misoprostol alone or in combination with mifepristone), participants completed a baseline survey, and then two follow-up phone surveys at 1 week and 3 weeks after taking pills. The primary outcome was the proportion of participants reporting a complete abortion without surgical intervention. Legal restrictions precluded enrolment of a concurrent clinical control group; thus, a non-inferiority analysis compared abortion completion among those in our self-managed medication abortion cohort with abortion completion reported in historical clinical trials using the same medication regimens, restricted to participants with pregnancies of less than 9 weeks' gestation. This study was registered with ISCRTN, ISRCTN95769543. Findings Between July 31, 2019, and April 27, 2020, we enrolled 1051 participants. We analysed abortion outcomes for 961 participants, with an additional 47 participants reached after the study period. Most pregnancies were less than 12 weeks' duration. Participants in follow-up self-managed their abortions using misoprostol alone (593 participants) or the combined regimen of misoprostol plus mifepristone (356 participants). At last follow-up, 586 (99%) misoprostol alone users and 334 (94%) combined regimen users had a complete abortion without surgical intervention. For those with pregnancies of less than 9 weeks' gestation, both regimens were non-inferior to medication abortion effectiveness in clinical settings. Interpretation Findings from this prospective cohort study show that self-managed medication abortion with accompaniment group support is highly effective and, for those with pregnancies of less than 9 weeks' gestation, non-inferior to the effectiveness of clinician-managed medication abortion administered in a clinical setting. These findings support the use of remote self-managed models of early abortion care, as well as telemedicine, as is being considered in several countries because of the COVID-19 pandemic. Funding David and Lucile Packard Foundation. Translations For the Arabic, French, Bahasa Indonesian, Spanish and Yoruba translations of the Article see Supplementary Materials section.
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Guendelman S, Pleasants E, Cheshire C, Kong A. Exploring Google Searches for Out-of-Clinic Medication Abortion in the United States During 2020: Infodemiology Approach Using Multiple Samples. JMIR INFODEMIOLOGY 2022; 2:e33184. [PMID: 37113801 PMCID: PMC10014087 DOI: 10.2196/33184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 01/18/2022] [Accepted: 03/31/2022] [Indexed: 04/29/2023]
Abstract
Background As access barriers to in-person abortion care increase due to legal restrictions and COVID-19-related disruptions, individuals may be turning to the internet for information and services on out-of-clinic medication abortions. Google searches allow us to explore timely population-level interest in this topic and assess its implications. Objective We examined the extent to which people searched for out-of-clinic medication abortions in the United States in 2020 through 3 initial search terms: home abortion, self abortion, and buy abortion pill online. Methods Using the Google Trends website, we estimated the relative search index (RSI)-a comparative measure of search popularity-for each initial search term and determined trends and its peak value between January 1, 2020, and January 1, 2021. RSI scores also helped to identify the 10 states where these searches were most popular. We developed a master list of top search queries for each of the initial search terms using the Google Trends application programming interface (API). We estimated the relative search volume (RSV)-the search volume of each query relative to other associated terms-for each of the top queries using the Google Health Trends API. We calculated average RSIs and RSVs from multiple samples to account for low-frequency data. Using the Custom Search API, we determined the top webpages presented to people searching for each of the initial search terms, contextualizing the information found when searching them on Google. Results Searches for home abortion had average RSIs that were 3 times higher than self abortion and almost 4 times higher than buy abortion pill online. Interest in home abortion peaked in November 2020, during the third pandemic wave, at a time when providers could dispense medication abortion using telemedicine and by mail. Home abortion was most frequently queried by searching for Planned Parenthood, abortion pill, and abortion clinic, presumably denoting varying degrees of clinical support. Consistently lower search popularity for self abortion and buy abortion pill online reflect less population interest in mostly or completely self-managed out-of-clinic abortions. We observed the highest interest for home abortion and self abortion in states hostile to abortion, suggesting that state restrictions encourage these online searches. Top webpages provided limited evidence-based clinical content on self-management of abortions, and several antiabortion sites presented health-related disinformation. Conclusions During the pandemic in the United States, there has been considerably more interest in home abortions than in minimally or nonclinically supported self-abortions. While our study was mainly descriptive, showing how infrequent abortion-related search data can be analyzed through multiple resampling, future studies should explore correlations between the keywords denoting interest in out-of-clinic abortion and abortion care measures and test models that allow for improved monitoring and surveillance of abortion concerns in our rapidly evolving policy context.
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Affiliation(s)
- Sylvia Guendelman
- Wallace Center for Maternal, Child, and Adolescent Health School of Public Health University of California, Berkeley Berkeley, CA United States
| | - Elizabeth Pleasants
- Wallace Center for Maternal, Child, and Adolescent Health School of Public Health University of California, Berkeley Berkeley, CA United States
| | - Coye Cheshire
- School of Information University of California, Berkeley Berkeley, CA United States
| | - Ashley Kong
- Computing, Data Science, and Society Program University of California, Berkeley Berkeley, CA United States
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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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Stevenson AJ. The Pregnancy-Related Mortality Impact of a Total Abortion Ban in the United States: A Research Note on Increased Deaths Due to Remaining Pregnant. Demography 2021; 58:2019-2028. [PMID: 34693444 PMCID: PMC10577877 DOI: 10.1215/00703370-9585908] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In this research note, I estimate one component of the mortality impact of denying all wanted induced abortions in the United States. This estimate quantifies the magnitude of an increase in pregnancy-related deaths that would occur solely because of the greater mortality risk of continuing a pregnancy rather than having a legal induced abortion. Using published statistics on pregnancy-related mortality ratios, births, and abortions, I estimate U.S. pregnancy-related deaths by race and ethnicity before and in the first and subsequent years of a hypothetical total abortion ban. The number of estimated deaths following a total abortion ban is determined by assuming three conditions: that all wanted induced abortions are denied, that each abortion denied leads to 0.8 births, and that there is a corresponding increase in exposure to pregnancy-related mortality. I find that in the first year of such a ban, estimated pregnancy-related deaths would increase from 675 to 724 (49 additional deaths, representing a 7% increase), and in subsequent years to 815 (140 additional deaths, for a 21% increase). Non-Hispanic Black people would experience the greatest increase in deaths (a 33% increase in subsequent years). Estimated pregnancy-related deaths would increase for all races and ethnicities examined. Overall, denying all wanted induced abortions in the United States would increase pregnancy-related mortality substantially, even if the rate of unsafe abortion did not increase.
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Affiliation(s)
- Amanda Jean Stevenson
- Department of Sociology and Institute of Behavioral Science, University of Colorado Boulder, Boulder, CO, USA
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41
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Mosley EA, Redd SK, Hartwig SA, Narasimhan S, Lemon E, Berry E, Lathrop E, Haddad L, Rochat R, Cwiak C, Hall KS. Racial and Ethnic Abortion Disparities Following Georgia's 22-Week Gestational Age Limit. Womens Health Issues 2021; 32:9-19. [PMID: 34711498 DOI: 10.1016/j.whi.2021.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 08/18/2021] [Accepted: 09/23/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Georgia's 2012 House Bill 954 (HB954) prohibiting abortions after 22 weeks from last menstrual period (LMP) has been associated with a significant decrease in abortions after 22 weeks. However, the policy's effects by race or ethnicity remain unexplored. We investigated whether changes in abortion numbers and ratios (per 1,000 live births) in Georgia after HB954 varied by race or ethnicity. METHODS Using Georgia Department of Public Health induced terminations of pregnancy data from 2007 to 2017, we examined changes in number of abortions and abortion ratios (per 1,000 live births) by race and ethnicity following HB954 implementation. RESULTS After full implementation of HB954 in 2015, the number of abortions and abortion ratios at or after 22 weeks (from last menstrual period) decreased among White (bNumber = -261.83, p < .001; bRatio = -3.31, p < .001), Black (bNumber = -416.17, p < .001; bRatio = -8.84, p < .001), non-Hispanic (bNumber = -667.00, p = .001; bRatio = -5.82, p < .001), and Hispanic (bNumber = -56.25, p = .002; bRatio = -2.44, p = .002) people. However, the ratio of abortions before 22 weeks increased for Black people (bLessThan22Weeks = 44.06, p = .028) and remained stable for White (bLessThan22Weeks = -6.78, p = .433), Hispanic (bLessThan22Weeks = 21.27, p = .212), and non-Hispanic people (bLessThan22Weeks = 26.93, p = .172). CONCLUSION The full implementation of HB954 had differential effects by race/ethnicity and gestational age. Although abortion at 22 weeks or more decreased for all groups, abortion at less than 22 weeks increased among Black people. Additional research should elucidate the possible causes, consequences, and reactions to differential effects of abortion restrictions by race and ethnicity.
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Affiliation(s)
- Elizabeth A Mosley
- Georgia State University, School of Public Health, Mark Chaffin Center for Healthy Development, Atlanta, Georgia; Emory University, Rollins School of Public Health, Atlanta, Georgia; Center for Reproductive Health Research in the Southeast (RISE), Atlanta, Georgia.
| | - Sara K Redd
- Emory University, Rollins School of Public Health, Atlanta, Georgia; Center for Reproductive Health Research in the Southeast (RISE), Atlanta, Georgia
| | - Sophie A Hartwig
- Emory University, Rollins School of Public Health, Atlanta, Georgia; Center for Reproductive Health Research in the Southeast (RISE), Atlanta, Georgia
| | - Subasri Narasimhan
- Emory University, Rollins School of Public Health, Atlanta, Georgia; Center for Reproductive Health Research in the Southeast (RISE), Atlanta, Georgia
| | - Emily Lemon
- Emory University, Rollins School of Public Health, Atlanta, Georgia; Center for Reproductive Health Research in the Southeast (RISE), Atlanta, Georgia
| | - Erin Berry
- Center for Reproductive Health Research in the Southeast (RISE), Atlanta, Georgia; Emory University, School of Medicine, Department of Gynecology and Obstetrics, Atlanta, Georgia
| | - Eva Lathrop
- Emory University, Rollins School of Public Health, Atlanta, Georgia; Center for Reproductive Health Research in the Southeast (RISE), Atlanta, Georgia; Emory University, School of Medicine, Department of Gynecology and Obstetrics, Atlanta, Georgia
| | - Lisa Haddad
- Center for Reproductive Health Research in the Southeast (RISE), Atlanta, Georgia; Emory University, School of Medicine, Department of Gynecology and Obstetrics, Atlanta, Georgia
| | - Roger Rochat
- Emory University, Rollins School of Public Health, Atlanta, Georgia; Center for Reproductive Health Research in the Southeast (RISE), Atlanta, Georgia; Emory University, School of Medicine, Department of Gynecology and Obstetrics, Atlanta, Georgia
| | - Carrie Cwiak
- Emory University, Rollins School of Public Health, Atlanta, Georgia; Center for Reproductive Health Research in the Southeast (RISE), Atlanta, Georgia; Emory University, School of Medicine, Department of Gynecology and Obstetrics, Atlanta, Georgia
| | - Kelli Stidham Hall
- Emory University, Rollins School of Public Health, Atlanta, Georgia; Center for Reproductive Health Research in the Southeast (RISE), Atlanta, Georgia
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Upadhyay UD, Cartwright AF, Grossman D. Barriers to abortion care and incidence of attempted self-managed abortion among individuals searching Google for abortion care: A national prospective study. Contraception 2021; 106:49-56. [PMID: 34560051 DOI: 10.1016/j.contraception.2021.09.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Studies on self-managed abortion conducted at abortion clinics may exclude those facing the greatest barriers to care. We aimed to assess association of attempted self-managed abortion with reported barriers to abortion care. STUDY DESIGN We used data from the Google Ads Abortion Access Study, a prospective cohort study that recruited people searching for abortion care on Google between August 2017 and April 2018. We used a stratified sampling design recruiting by state to ensure representation from all 50 states. Participants completed an online baseline survey and follow-up 4 weeks later. We modeled the adjusted odds of attempting self-managed abortion using multivariable logistic regression, with random effects for state of residence. We assessed attempted self-managed abortion at follow-up by asking: "Did you take or try to do any of the following to try to end this pregnancy?" with a closed-ended list of methods. RESULTS Among 856 participants with follow-up data, 28% (95% confidence interval [95% CI]: 25%-31%) reported attempting self-managed abortion. Most common methods used were: herbs, supplements, or vitamins (52%); emergency contraception or many contraceptive pills (19%); mifepristone and/or misoprostol (18%); and abdominal or other physical trauma (18%). Participants still seeking abortion at 4 weeks were more likely to attempt self-management (33%) than those planning to carry to term (20%, p < 0.001). Reporting having to keep the abortion a secret, fearing for one's safety/well-being, needing to gather money for travel or the abortion, or living further from an abortion facility as barriers were associated with higher odds of attempts. CONCLUSIONS Attempted self-managed abortion is higher among people facing barriers to abortion care. IMPLICATIONS Reducing financial and distance barriers, such as by removing legal restrictions on abortion, could help reduce attempted self-managed abortion. Additionally, removing restrictions on telehealth for abortion could reduce attempted self-managed abortion. Efforts are needed to permanently remove United States Food and Drug Administration (FDA) regulations and state policies prohibiting telehealth for medication abortion, thereby allowing individuals to end their pregnancies without a clinic visit.
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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 (UCSF), San Francisco, CA, United States.
| | - Alice F Cartwright
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
| | - Daniel Grossman
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco (UCSF), San Francisco, CA, United States
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Eagen-Torkko M, Yanow S. The Critical Role of Midwives in Safe Self-Managed Abortion. J Midwifery Womens Health 2021; 66:795-800. [PMID: 34549524 DOI: 10.1111/jmwh.13289] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 08/19/2021] [Accepted: 08/21/2021] [Indexed: 11/28/2022]
Abstract
As access to legal abortion in the United States becomes more complex, there is increasing interest in self-managed abortion. Choosing to seek abortion care outside the clinical setting can also help people marginalized or harmed by existing health care systems to access needed care in a way that feels safe and empowering. However, patients and midwives alike often have a lack of information about expected outcomes and potential complications that may arise, as well as how to manage these in a health care system that may make appropriate follow-up difficult to access if needed. This article discusses patient education as a harm-reduction approach, and reviews ways that midwives may strategically and ethically participate in this patient education need. As trusted health care providers who are expert in pregnancy and reproductive health, midwives are ideally positioned to meet patient knowledge needs around self-managed abortion.
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Affiliation(s)
- Meghan Eagen-Torkko
- University of Washington Bothell & Public Health Seattle-King County, Seattle, Washington
| | - Susan Yanow
- Reproductive Health Consultant, Cambridge, Massachusetts
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Sisson G. Estimating the annual domestic adoption rate and lifetime incidence of infant relinquishment in the United States . Contraception 2021; 105:14-18. [PMID: 34418378 DOI: 10.1016/j.contraception.2021.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Estimating the rate of infant relinquishment for adoption in the United States (U.S.) can inform understandings of pregnancy decision-making and adoption practice. Yet, private domestic adoptions are not systematically tracked. Most methods of estimating adoptions rely on nonmarital birth rates, despite the changing social context of nonmarital births. This analysis provides updated estimates of the rate of infant relinquishment for private domestic adoption in the United States. STUDY DESIGN Using data from National Council for Adoption, Centers for Disease Control, and Guttmacher Institute, I compiled annual estimates for the number and rates of births, abortions, and adoptions; calculated annual domestic infant adoption rates among all women and unmarried women of reproductive age; estimated the number of adoptions as a proportion of marital and nonmarital births; and estimated the lifetime incidence of relinquishment for U.S. women. RESULTS Since 1982, the annual adoption rate per 1000 U.S. women of reproductive age has been between 0.32 and 0.45, decreasing for the last 30 years. The most recent adoption rate translates to a lifetime relinquishment estimate of 0.9% of U.S. women. Based on patterns from 2002 to 2014, I estimate the current number of private domestic adoptions to be approximately 0.5% the annual number of births, or about 18,300 to 20,000 adoptions per year. CONCLUSIONS Despite finding a higher estimate of private domestic adoptions per year than previous estimates, adoption relinquishment rates remain dramatically lower than birth (and thus parenting) and abortion rates in the U.S. IMPLICATIONS National and state level information about annual adoptions is needed to inform policies regarding adoption, abortion, and support for families.
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Affiliation(s)
- Gretchen Sisson
- University of California, San Francisco, San Francisco, CA, United States.
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Desai S, Lindberg LD, Maddow-Zimet I, Kost K. The Impact of Abortion Underreporting on Pregnancy Data and Related Research. Matern Child Health J 2021; 25:1187-1192. [PMID: 33929651 PMCID: PMC8279977 DOI: 10.1007/s10995-021-03157-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The impact on research findings that use pregnancy data from surveys with underreported abortions is not well-established. We estimate the percent of all pregnancies missing from women's self-reported pregnancy histories because of abortion underreporting. METHODS We obtained abortion and fetal loss data from the 2006-2015 National Survey of Family Growth (NSFG), annual counts of births from US vital statistics, and external abortion counts from the Guttmacher Institute. We estimated the completeness of abortion reporting in the NSFG as compared to the external counts, the proportion of pregnancies resolving in abortion, and the proportion of pregnancies missing in the NSFG due to missing abortions. Each measure was examined overall and by age, race/ethnicity, union status, and survey period. RESULTS Fewer than half of abortions (40%, 95% CI 36-44) that occurred in the five calendar years preceding respondents' interviews were reported in the NSFG. In 2006-2015, 18% of pregnancies resolved in abortion, with significant variation across demographic groups. Nearly 11% of pregnancies (95% CI 10-11) were missing from the 2006-2015 NSFG due to abortion underreporting. The extent of missing pregnancies varied across demographic groups and was highest among Black women and unmarried women (18% each); differences reflect both the patterns of abortion underreporting and the share of pregnancies ending in abortion. DISCUSSION Incomplete reporting of pregnancy remains a fundamental shortcoming to the study of US fertility-related experiences. Efforts to improve abortion reporting are needed to strengthen the quality of pregnancy data to support maternal, child, and reproductive health research.
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Affiliation(s)
- Sheila Desai
- Guttmacher Institute, 125 Maiden Lane, 7th Floor, New York, NY, 10038, USA
| | - Laura D Lindberg
- Guttmacher Institute, 125 Maiden Lane, 7th Floor, New York, NY, 10038, USA.
| | - Isaac Maddow-Zimet
- Guttmacher Institute, 125 Maiden Lane, 7th Floor, New York, NY, 10038, USA
| | - Kathryn Kost
- Guttmacher Institute, 125 Maiden Lane, 7th Floor, New York, NY, 10038, 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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Aiken ARA, Starling JE, Gomperts R. Factors Associated With Use of an Online Telemedicine Service to Access Self-managed Medical Abortion in the US. JAMA Netw Open 2021; 4:e2111852. [PMID: 34019085 PMCID: PMC8140373 DOI: 10.1001/jamanetworkopen.2021.11852] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [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 People in the US have been seeking self-managed abortions outside the formal health care system using medications obtained through online telemedicine. However, little is known about this practice, including potential motivating factors. OBJECTIVE To examine individual reasons for accessing medication abortion through an online telemedicine service as well as associations between state- and county-level factors and the rate of requests. DESIGN, SETTING, AND PARTICIPANTS This population-based cross-sectional study examined all requests for self-managed medication abortion through an online consultation form available from Aid Access, a telemedicine service in the US, between March 20, 2018, and March 20, 2020. MAIN OUTCOMES AND MEASURES Individual-level reasons for accessing the telemedicine service were examined as well as the rate of requests per 100 000 women of reproductive age by state. Zip code data provided by individuals making requests were used to examine county-level factors hypothesized to be associated with increased demand for self-managed abortion: distance to a clinic (calculated using location data for US abortion clinics) and the population proportion identifying as a member of a racial/ethnic minority group, living below the federal poverty level, and having broadband internet access (calculated using census data). RESULTS During the 2-year study period, 57 506 individuals in 2458 counties in 50 states requested self-managed medication abortion; 52.1% were aged 20 to 29 years (mean [SD] age, 25.9 [6.7] years), 50.0% had children, and 99.9% were 10 weeks' pregnant or less. The most common reasons cited by individuals making requests were the inability to afford in-clinic care (73.5%), privacy (49.3%), and clinic distance (40.4%). States with the highest rate of requests were Louisiana (202.7 per 100 000 women) and Mississippi (199.9 per 100 000 women). At the county level, an increase of 1 SD (47 miles) in distance to the nearest clinic was significantly associated with a 41% increase in requests (incidence rate ratio, 1.41; 95% CI, 1.31-1.51; P < .001), and a 10% increase in the population living below the federal poverty level was significantly associated with a 20% increase in requests (incidence rate ratio, 1.20; 95% CI, 1.13-1.28; P < .001). CONCLUSIONS AND RELEVANCE In this cross-sectional study, clinic access barriers were the most commonly cited reason for requesting self-managed medication abortion using an online telemedicine service. At the county level, distance to an abortion clinic and living below the federal poverty level were associated with a higher rate of requests. State and federal legislation could address these access barriers.
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Affiliation(s)
- Abigail R. A. Aiken
- LBJ School of Public Affairs, The University of Texas at Austin
- Population Research Center, The University of Texas at Austin
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