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Missouri's Abortion law: Access to care for Patients with Lethal Fetal Anomalies at a Midwest Tertiary care Center. Matern Child Health J 2023; 27:468-475. [PMID: 36352286 PMCID: PMC9646264 DOI: 10.1007/s10995-022-03511-5] [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: 09/06/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Missouri passed an 8-week gestational age abortion in August 2019. The objective of this study was to compare distance and time from referral to evaluation between patients who continued their pregnancy and those who terminated in patients with severe and lethal fetal anomalies and estimate the impact of the Missouri gestational age abortion ban on distance to abortion care in this patient population. METHODS This is a retrospective cohort study of patients seen at the Washington University in St. Louis (WUSTL) Fetal Care Center (FCC) with a severe or lethal fetal anomaly between July 2018 and June 2019. Patient characteristics including gestational age at referral and distance traveled to the FCC were compared between patients who underwent abortion and who continued their pregnancies. RESULTS From July 2018 to June 2019, 463 patients were seen in the Fetal Care Center and 13% (60/463) were diagnosed with severe or lethal fetal anomalies comprising the study population for this analysis. Of these, 21 (35%) patients underwent an abortion, and 39 (65%) patients continued their pregnancy. Patients who underwent abortion were referred at a significantly earlier gestational age (median 19 weeks [IQR 17, 20 weeks] v. 20 weeks [IQR 18, 24 weeks]), p = 0.04. There was a statistically significant difference between the median latency time between patients who underwent an abortion and who continued their pregnancy (median 8 days [IQR 4,13 days] v. 14 days [IQR 9, 22 days], p < 0.01). CONCLUSION Patients with severe or lethal fetal anomalies are often evaluated at later gestational ages, which may preclude their access to abortion services.
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Cutler AS, Swan LT, Lands M, Schmuhl NB, Higgins JA. Characterizing physician concerns with publicly supporting abortion at Wisconsin's largest medical school. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2023; 55:23-27. [DOI: https:/doi.org/10.1363/psrh.12218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Affiliation(s)
- Abigail S. Cutler
- Department of Obstetrics and Gynecology UW‐Madison Madison Wisconsin USA
| | - Laura T. Swan
- Department of Population Health Sciences, Collaborative for Reproductive Equity (CORE) UW‐Madison Madison Wisconsin USA
| | - Madison Lands
- Department of Obstetrics and Gynecology, Collaborative for Reproductive Equity (CORE) UW‐Madison Madison Wisconsin USA
| | | | - Jenny A. Higgins
- Department of Obstetrics and Gynecology, Collaborative for Reproductive Equity (CORE) UW‐Madison Madison Wisconsin USA
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3
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Cutler AS, Swan LT, Lands M, Schmuhl NB, Higgins JA. Characterizing physician concerns with publicly supporting abortion at Wisconsin's largest medical school. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2023; 55:23-27. [PMID: 36629513 DOI: 10.1363/psrh.12218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To examine factors associated with physicians' level of concern and perceived consequences of publicly supporting abortion at Wisconsin's largest and only publicly funded medical school. METHODS We surveyed physicians at the University of Wisconsin School of Medicine and Public Health about their knowledge, attitudes, and referral practices regarding abortion care. Among those who expressed support for abortion (N = 701), we analyzed perceived concerns about making their support public. RESULTS Nearly a quarter (22%) of respondents felt very or extremely concerned that taking a strong public stance on abortion would alienate patients and 17% felt very or extremely concerned that doing so would alienate coworkers. More than a quarter (27%) felt very or extremely concerned that publicly supporting abortion would lead to harassment or harm. Those with greater concerns about expressing public support for abortion were comparatively less willing to refer for or participate in abortion care themselves. CONCLUSIONS Many physicians supportive of abortion reported concerns over publicizing their support for this common health care service. These concerns may render physicians less likely to refer patients for needed abortion care or weigh in on abortion policy.
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Affiliation(s)
- Abigail S Cutler
- Department of Obstetrics and Gynecology, UW-Madison, Madison, Wisconsin, USA
| | - Laura T Swan
- Department of Population Health Sciences, Collaborative for Reproductive Equity (CORE), UW-Madison, Madison, Wisconsin, USA
| | - Madison Lands
- Department of Obstetrics and Gynecology, Collaborative for Reproductive Equity (CORE), UW-Madison, Madison, Wisconsin, USA
| | | | - Jenny A Higgins
- Department of Obstetrics and Gynecology, Collaborative for Reproductive Equity (CORE), UW-Madison, Madison, Wisconsin, USA
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4
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Espey E, Haider S, Stone J, Gyamfi-Bannerman C, Steinauer J. Now is the time to stand up for reproductive justice and abortion access. Am J Obstet Gynecol 2023; 228:48-52. [PMID: 36008167 DOI: 10.1016/j.ajog.2022.07.033] [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: 05/14/2022] [Revised: 07/08/2022] [Accepted: 07/18/2022] [Indexed: 01/26/2023]
Abstract
The ongoing assault on abortion care in the United States culminating in the Supreme Court decision that overturned Roe v Wade calls for concerted national action to address the major gaps in care and training that will ensue. We write this call to action to our community of obstetrician-gynecologists to prioritize advocacy for access to abortion care. Professional health organizations understand the importance of access to contraception and abortion care as the foundation for reproductive health, autonomy, and empowerment. As restrictions proliferate, patients are encountering significant challenges in accessing care; all in our community who provide obstetrical and gynecologic care need to step up to ensure adequate and equitable patient care and provider training. In this Clinical Opinion, we outline current professional organization evidence-based support for comprehensive reproductive health care including abortion care, without interference by politics, strategies to proactively prevent further restrictions, and actions to mitigate the harm that will be caused by further restrictions to abortion care. We must all speak up, be visible in our support, and take any and every opportunity to advocate for abortion care as an integral part of comprehensive reproductive medical care.
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Affiliation(s)
- Eve Espey
- Department of Obstetrics & Gynecology, School of Medicine, The University of New Mexico, Albuquerque, NM.
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5
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Lindberg LD, Maddow‐Zimet I, Mueller J, VandeVusse A. Randomized experimental testing of new survey approaches to improve abortion reporting in the United States. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2022; 54:142-155. [PMID: 36511507 PMCID: PMC10107886 DOI: 10.1363/psrh.12217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
CONTEXT Abortions are substantially underreported in surveys due to social stigma, compromising the study of abortion, pregnancy, fertility, and related demographic and health outcomes. METHODS In this study, we evaluated six methodological approaches identified through formative mixed-methods research to improve the measurement of abortion in surveys. These approaches included altering the placement of abortion items in the survey, the order of pregnancy outcome questions, the level of detail, the introduction to the abortion question, and the context of the abortion question, and using graduated sensitivity. We embedded a preregistered randomized experiment in a newly designed online survey about sexual and reproductive health behaviors (N = 6536). We randomized respondents to experimental arms in a fully crossed factorial design; we estimated an average treatment effect using standardized estimators from logistic regression models, adjusted for demographic covariates associated with reporting. RESULTS None of the experimental arms significantly improved abortion reporting compared to the control condition. CONCLUSION More work is needed to improve reporting of abortion in future surveys, particularly as abortion access becomes increasingly restricted in the United States. Despite this study's null results, it provides a promising path for future efforts to improve abortion measurement. It is proof of concept for testing new approaches in a less expensive, faster, and more flexible format than embedding changes in existing national fertility surveys.
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Affiliation(s)
- Laura D. Lindberg
- Department of Urban‐Global HealthRutgers School of Public Health (formerly at the Guttmacher Institute)PiscatawayNew JerseyUSA
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6
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Gerdts C, Rupani A, Conner K, Ragosta S. Collapse of the Abortion Care Infrastructure: There Aren't Enough Hands to Fill the Gaps. Am J Public Health 2022; 112:1278-1279. [PMID: 35901317 PMCID: PMC9382157 DOI: 10.2105/ajph.2022.306994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Caitlin Gerdts
- Caitlin Gerdts is vice president for research, Ibis Reproductive Health, Oakland, CA. Anna Rupani is executive director, Fund Texas Choice, Austin. Kamyon Conner is executive director, Texas Equal Access Fund, Dallas. Sachiko Ragosta is a research coordinator at Ibis Reproductive Health, Oakland, CA
| | - Anna Rupani
- Caitlin Gerdts is vice president for research, Ibis Reproductive Health, Oakland, CA. Anna Rupani is executive director, Fund Texas Choice, Austin. Kamyon Conner is executive director, Texas Equal Access Fund, Dallas. Sachiko Ragosta is a research coordinator at Ibis Reproductive Health, Oakland, CA
| | - Kamyon Conner
- Caitlin Gerdts is vice president for research, Ibis Reproductive Health, Oakland, CA. Anna Rupani is executive director, Fund Texas Choice, Austin. Kamyon Conner is executive director, Texas Equal Access Fund, Dallas. Sachiko Ragosta is a research coordinator at Ibis Reproductive Health, Oakland, CA
| | - Sachiko Ragosta
- Caitlin Gerdts is vice president for research, Ibis Reproductive Health, Oakland, CA. Anna Rupani is executive director, Fund Texas Choice, Austin. Kamyon Conner is executive director, Texas Equal Access Fund, Dallas. Sachiko Ragosta is a research coordinator at Ibis Reproductive Health, Oakland, CA
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7
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Zhang X, Guan Q, Yu Q, Xiao W, Chen Z, Dong C, Deng S, Zhuang Y, Xia Y. Estimating the effects of policies on infertility prevalence worldwide. BMC Public Health 2022; 22:1378. [PMID: 35854262 PMCID: PMC9295370 DOI: 10.1186/s12889-022-13802-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 07/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background Infertility has troubled millions of people worldwide while always being an ignored issue. The high cost of treatment or lack of services placed a barrier to the alleviation of infertility status. Governments play a significant role to promote infertility-related policies for better access to infertility services and comprehensive supports for infertile people. Methods Data of infertility status indicators and infertility-related policies in ten representative countries were collected. An infertility-related policy system was established, then classification and quantification were processed according to specific criteria, and different policy implementation patterns were identified. The effectiveness of specific infertility-related policy and various patterns on infertility prevalence relief between 1990 and 2017 were evaluated via generalized linear models and analyses of covariance for the first time. Results Economic support policies would be less prioritized compared with social security policies, while economic support policy had a significant positive role in the decline of female infertility prevalence (β = -2·16, p = 0·042). In detail, insurance coverage and economic reward policies were crucial (β = -3·31, p = 0·031; β = -4·10, p = 0·025) with adjusted with covariates. The effect of economic support-oriented pattern was relatively better than other patterns for both male and female infertility prevalence relief. Nevertheless, the effectiveness of gradual-promotion pattern seemed preferable for male infertility prevalence relief while was similar with simultaneous-promotion pattern for females. Conclusions Our data-driven analysis revealed that insurance coverage and economic reward policies played the pivotal role in moderation of female infertility status. Economic support-oriented pattern and gradual-promotion pattern were preferable when promoting infertility-related policies. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13802-9.
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Affiliation(s)
- Xiaochen Zhang
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, No.101 Longmian Road, Nanjing, 211166, China.,Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Quanquan Guan
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, No.101 Longmian Road, Nanjing, 211166, China.,Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Qiurun Yu
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, No.101 Longmian Road, Nanjing, 211166, China.,Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Wenwen Xiao
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, No.101 Longmian Road, Nanjing, 211166, China.,Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Ziyu Chen
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, No.101 Longmian Road, Nanjing, 211166, China.,Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Chao Dong
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, No.101 Longmian Road, Nanjing, 211166, China.,Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Siting Deng
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, No.101 Longmian Road, Nanjing, 211166, China.,Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Yin Zhuang
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, No.101 Longmian Road, Nanjing, 211166, China.,Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Yankai Xia
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, No.101 Longmian Road, Nanjing, 211166, China. .,Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, 211166, China.
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The Impact of First-Person Abortion Stories on Community-Level Abortion Stigma: A Randomized Trial. Womens Health Issues 2022; 32:578-585. [PMID: 35778255 DOI: 10.1016/j.whi.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 06/10/2022] [Accepted: 06/10/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We aimed to assess the impact of first-person abortion stories on community-level abortion stigma. METHODS Between November 2018 and March 2019, we recruited participants and analyzed data from a nationally representative, probability-based online panel of U.S. adults, randomized to watch three first-person abortion video stories (intervention, n = 460) or three nature videos (control, n = 426). We measured community-level abortion stigma using the Community Abortion Attitudes Scale, Reproductive Experiences and Events Scale, and Community Level Abortion Stigma Scale at baseline, immediately after video exposure, and 3 months later. We dichotomized stigma change scores as decreased stigma compared with no change or increased stigma. Bivariate and logistic regression analysis accounted for complex survey methodology and sample weighting. RESULTS Sample demographics reflected U.S. Census benchmarks (51% female, 68% White, 47% aged 18-44 years). Most participants (83.1%) completed the 3-month follow-up. Viewing the intervention videos was not associated with decreased stigma measured by Community Abortion Attitudes Scale or Community Level Abortion Stigma Scale immediately (odds ratio [OR], 0.80; 95% confidence interval [CI], 0.59-1.09; OR, 1.28; 95% CI, 0.93-1.75) or at the 3-month follow-up (OR, 0.86; 95% CI, 0.62-1.19; OR, 0.98; 95% CI, 0.70-1.37). Intervention exposure was associated with decreased stigma as measured by Reproductive Experiences and Events Scale immediately (OR, 1.74; 95% CI, 1.23-2.46); however, this association was not observed at the 3-month follow-up (OR, 0.98; 95% CI, 0.70-1.37). CONCLUSIONS Exposure to first-person video stories may not decrease community-level abortion stigma among U.S. adults.
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9
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Gordon MR, Coverdale J, Chervenak FA, McCullough LB. Undue burdens created by the Texas Abortion Law for vulnerable pregnant women. Am J Obstet Gynecol 2022; 226:529-534. [PMID: 34954218 DOI: 10.1016/j.ajog.2021.12.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 12/09/2021] [Accepted: 12/17/2021] [Indexed: 11/25/2022]
Abstract
The new Texas abortion law requires the physician to determine whether a fetal heartbeat is present and prohibits abortion after a heartbeat has been documented. An exception is allowed when a "medical emergency necessitated the abortion." These and other provisions of the statute are to be enforced through "civil actions" brought by private citizens. This article identifies 3 populations of vulnerable women who will experience undue burdens created by the Texas abortion law. We begin with an account of the concept of undue burden in the jurisprudence of abortion, as expressed in the 1992 US Supreme Court case, Planned Parenthood v. Casey of Southeastern Pennsylvania. We then provide an evidence-based account of the predictable, undue burdens for 3 populations of vulnerable women: pregnant women with decreased freedom of movement; pregnant minors; and pregnant women with major mental disorders and cognitive disabilities. The Texas law creates an undue burden on these 3 populations of vulnerable women by reducing or even eliminating access to abortion services outside of Texas. The Texas law also creates an undue burden by preventably increasing the risks of morbidity, including loss of fertility, and mortality for these 3 populations of vulnerable women. For these women, it is indisputable that the Texas law will create undue burdens and is therefore not compatible with the jurisprudence of abortion as set forth in Planned Parenthood v. Casey because a "significant number of women will likely be prevented from obtaining an abortion." Federal courts should therefore strike down this law.
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10
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Supporting Staff in Southern Family Planning Clinics: Challenges and Opportunities. Matern Child Health J 2022; 26:319-327. [PMID: 34997438 PMCID: PMC8813695 DOI: 10.1007/s10995-021-03339-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2021] [Indexed: 11/30/2022]
Abstract
Objectives The aim of this study was to identify key challenges and opportunities to better support non-clinician clinic staff at family planning centers in Southern US states. Methods We conducted qualitative interviews with 15 individuals in clinic staff and leadership positions at family planning centers in seven Southern states. Results Turnover had negative impacts on both clinic functioning as well as patient care. Participants identified several challenges related to recruitment and retention in family planning health centers in the South, including the conservative contextual landscape, the perceived value of support staff, gaps in communication, and rural locations. In response to these challenges, staff also identified key strategies to better support and retain health center workers. These included prioritizing investment in management, creating career advancement opportunities, prioritizing staff retention, and creating space for self-care. Health center staff and leadership who used these strategies to support and retain staff noted improvements in the effectiveness of staff work as well as increases in patient volume. Conclusions for Practice Study findings provide key areas for intervention including providing development opportunities, commitment from leadership to recognize and invest in staff and supporting self-care. Focusing on ensuring internal organizational justice for staff may also facilitate resilience to external challenging environments. Better supporting clinic staff is likely also important for quality services and ensures the full workforce involved in providing family planning care can work at full capacity.
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11
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Agénor M, Murchison GR, Najarro J, Grimshaw A, Cottrill AA, Janiak E, Gordon AR, Charlton BM. Mapping the scientific literature on reproductive health among transgender and gender diverse people: a scoping review. Sex Reprod Health Matters 2021; 29:1886395. [PMID: 33625311 PMCID: PMC8011687 DOI: 10.1080/26410397.2021.1886395] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
We conducted a scoping review to map the extent, range and nature of the scientific research literature on the reproductive health (RH) of transgender and gender diverse assigned female at birth and assigned male at birth persons. A research librarian conducted literature searches in Ovid MEDLINE®, Ovid Embase, the Cochrane Library, PubMed, Google Scholar, Gender Studies Database, Gender Watch, and Web of Science Core Collection. The results were limited to peer-reviewed journal articles published between 2000 and 2018 involving human participants, written in English, pertaining to RH, and including disaggregated data for transgender and gender diverse people. A total of 2197 unique citations with abstracts were identified and entered into Covidence. Two independent screeners performed a title and abstract review and selected 75 records for full-text review. The two screeners independently extracted data from 37 eligible articles, which were reviewed, collated, summarised, and analysed using a numerical summary and thematic analysis approach. The existing scientific research literature was limited in terms of RH topics, geographic locations, study designs, sampling and analytical strategies, and populations studied. Research is needed that: focuses on the full range of RH issues; includes transgender and gender diverse people from the Global South and understudied and multiply marginalised subpopulations; is guided by intersectionality; and uses intervention, implementation science, and community-based participatory research approaches. Further, programmes, practices, and policies that address the multilevel barriers to RH among transgender and gender diverse people addressed in the existing scientific literature are warranted.
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Affiliation(s)
- Madina Agénor
- Gerald R. Gill Assistant Professor, Department of Community Health, Tufts University, Medford, MA, USA; Adjunct Faculty, Department of Obstetrics and Gynecology, Tufts University School of Medicine, and The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Gabriel R. Murchison
- PhD Student, Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Jesse Najarro
- Undergraduate Student, Department of Community Health, Tufts University, Medford, MA, USA
| | - Alyssa Grimshaw
- Clinical Research and Education Librarian, Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, USA
| | - Alischer A. Cottrill
- Research Coordinator, Planned Parenthood League of Massachusetts, Boston, MA, USA
| | - Elizabeth Janiak
- Director of Social Science Research, Planned Parenthood League of Massachusetts, Boston, MA, USA; Assistant Professor, Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women’s Hospital, Boston, MA, USA and Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA, USA; Instructor, Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Allegra R. Gordon
- Assistant Professor, Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA; Instructor, Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA, and Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Brittany M. Charlton
- Assistant Professor, Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA, Department of Pediatrics, Harvard Medical School, Boston, MA, USA and Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
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12
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Vilda D, Wallace ME, Daniel C, Evans MG, Stoecker C, Theall KP. State Abortion Policies and Maternal Death in the United States, 2015‒2018. Am J Public Health 2021; 111:1696-1704. [PMID: 34410825 PMCID: PMC8589072 DOI: 10.2105/ajph.2021.306396] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2021] [Indexed: 11/04/2022]
Abstract
Objectives. To examine associations between state-level variation in abortion-restricting policies in 2015 and total maternal mortality (TMM), maternal mortality (MM), and late maternal mortality (LMM) from 2015 to 2018 in the United States. Methods. We derived an abortion policy composite index for each state based on 8 state-level abortion-restricting policies. We fit ecological state-level generalized linear Poisson regression models with robust standard errors to estimate 4-year TMM, MM, and LMM rate ratios and 95% confidence intervals (CIs) associated with a 1-unit increase in the abortion index, adjusting for state-level covariates. Results. States with the higher score of abortion policy composite index had a 7% increase in TMM (adjusted rate ratio [ARR] = 1.07; 95% CI = 1.02, 1.12) compared with states with lower abortion policy composite index, after we adjusted for state-level covariates. Among individual abortion policies, states with a licensed physician requirement had a 51% higher TMM (ARR = 1.51; 95% CI = 1.15, 1.99) and a 35% higher MM (ARR = 1.35; 95% CI = 1.09, 1.67), and states with restrictions on Medicaid coverage of abortion care had a 29% higher TMM (ARR = 1.29; 95% CI = 1.03, 1.61). Conclusions. Restricting access to abortion care at the state level may increase the risk for TMM.
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Affiliation(s)
- Dovile Vilda
- Dovile Vilda, Maeve E. Wallace, Melissa Goldin Evans, and Katherine P. Theall are with Mary Amelia Center for Women's Health Equity Research; Department of Social, Behavioral, and Population Sciences; Tulane University School of Public Health and Tropical Medicine; New Orleans, LA. Clare Daniel is with Newcomb Institute, Tulane University, New Orleans. Charles Stoecker is with the Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine
| | - Maeve E Wallace
- Dovile Vilda, Maeve E. Wallace, Melissa Goldin Evans, and Katherine P. Theall are with Mary Amelia Center for Women's Health Equity Research; Department of Social, Behavioral, and Population Sciences; Tulane University School of Public Health and Tropical Medicine; New Orleans, LA. Clare Daniel is with Newcomb Institute, Tulane University, New Orleans. Charles Stoecker is with the Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine
| | - Clare Daniel
- Dovile Vilda, Maeve E. Wallace, Melissa Goldin Evans, and Katherine P. Theall are with Mary Amelia Center for Women's Health Equity Research; Department of Social, Behavioral, and Population Sciences; Tulane University School of Public Health and Tropical Medicine; New Orleans, LA. Clare Daniel is with Newcomb Institute, Tulane University, New Orleans. Charles Stoecker is with the Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine
| | - Melissa Goldin Evans
- Dovile Vilda, Maeve E. Wallace, Melissa Goldin Evans, and Katherine P. Theall are with Mary Amelia Center for Women's Health Equity Research; Department of Social, Behavioral, and Population Sciences; Tulane University School of Public Health and Tropical Medicine; New Orleans, LA. Clare Daniel is with Newcomb Institute, Tulane University, New Orleans. Charles Stoecker is with the Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine
| | - Charles Stoecker
- Dovile Vilda, Maeve E. Wallace, Melissa Goldin Evans, and Katherine P. Theall are with Mary Amelia Center for Women's Health Equity Research; Department of Social, Behavioral, and Population Sciences; Tulane University School of Public Health and Tropical Medicine; New Orleans, LA. Clare Daniel is with Newcomb Institute, Tulane University, New Orleans. Charles Stoecker is with the Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine
| | - Katherine P Theall
- Dovile Vilda, Maeve E. Wallace, Melissa Goldin Evans, and Katherine P. Theall are with Mary Amelia Center for Women's Health Equity Research; Department of Social, Behavioral, and Population Sciences; Tulane University School of Public Health and Tropical Medicine; New Orleans, LA. Clare Daniel is with Newcomb Institute, Tulane University, New Orleans. Charles Stoecker is with the Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine
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13
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Society for Maternal-Fetal Medicine Special Statement: Maternal-fetal medicine subspecialist survey on abortion training and service provision. Am J Obstet Gynecol 2021; 225:B2-B11. [PMID: 33845031 DOI: 10.1016/j.ajog.2021.04.220] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Following a collaborative workshop at the 39th Annual Pregnancy Meeting, the Society for Maternal-Fetal Medicine Reproductive Health Advisory Group identified a need to assess the attitudes of maternal-fetal medicine subspecialists about abortion services and the available resources at the local and regional levels. The purpose of this study was to identify trends in attitudes, beliefs, and behaviors of practicing maternal-fetal medicine subspecialists in the United States regarding abortion. An online survey was distributed to associate and regular members of the Society for Maternal-Fetal Medicine to assess their personal training experience, abortion practice patterns, factors that influence their decision to provide abortion care, and their responses to a series of scenarios about high-risk maternal or fetal medical conditions. Frequencies were analyzed and univariable and multivariable analyses were conducted on the survey responses. Of the 2751 members contacted, 546 Society for Maternal-Fetal Medicine members completed all (448 of 546, 82.1%) or some (98 of 546, 17.9%) of the survey. More than 80% of the respondents reported availability of abortion services in their state, 70% reported availability at their primary institution, and 44% reported provision as part of their personal medical practice. Ease of referral to family planning subspecialists or other abortion providers, institutional restrictions, and the lack of training or continuing education were identified as the most significant factors contributing to the respondents' limited scope of abortion services or lack of any abortion services offered. In the univariable analysis, exposure to formal family planning training programs, fewer years since the completion of residency, current practice setting not being religiously affiliated, and current state categorized as supportive by the Guttmacher Institute's abortion policy landscape were factors associated with abortion provision (all P values <.01). After controlling for these factors in a multivariable regression, exposure to formal family planning training programs was no longer associated with current abortion provision (P=.20; adjusted odds ratio, 1.34; 95% confidence interval, 0.85-2.10), whereas a favorable state policy environment and fewer years since the completion of residency remained associated with abortion provision. The results of this survey suggest that factors at the individual, institutional, and state levels affect the provision of abortion care by maternal-fetal medicine subspecialists. The subspecialty of maternal-fetal medicine should be active in ensuring adequate training and education to create a community of maternal-fetal medicine physicians able to provide comprehensive reproductive healthcare services.
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Tomlinson SJ. Access Denied: The Proliferation of American Medical Abortion Laws, 2000-2018. Am J Prev Med 2021; 60:497-503. [PMID: 33612338 DOI: 10.1016/j.amepre.2020.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 10/30/2020] [Accepted: 11/06/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Medical abortion is a safe, effective, and often preferred method of terminating an unintended pregnancy, but access can be made difficult by the laws of a state. Despite modern efforts to prevent unintended pregnancies in the U.S., they comprise almost half of pregnancies and 95% of abortions, signifying that abortion is a necessary and desired healthcare service. This study's purpose is to describe the proliferation of American medical abortion access laws between 2000 and 2018. METHODS Policy surveillance methods were used in 2018 to collect 7 types of U.S. medical abortion access restriction laws in place as of December 1, 2018. Statutory histories were reviewed in 2019 to record the laws' years of enactment, substantive amendment, and repeal. RESULTS A total of 35 states restricted medical abortion access as of 2018. Medical abortion laws increased from 16 in 2000 to 96 by 2018, and only 1 was repealed. A total of 25 states had multiple laws restricting medical abortion access in 2018. Medical abortion access laws surged from 2010 to 2017, but none were passed in 2018. Medical abortion access is generally most restricted in Midwestern and Southern states and least restricted in Western and Northeastern states. CONCLUSIONS Although evidence demonstrates medical abortion's safety and efficacy, its access is increasingly limited by law in many states. Further research examining the impacts of these laws on women's health and the consequences of unintended births on women, children, families, and society is needed.
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Affiliation(s)
- Sarah J Tomlinson
- Department of Health Policy and Health Services Research, Temple University College of Public Health, Philadelphia, Pennsylvania.
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Cutler AS, Lundsberg LS, White MA, Stanwood NL, Gariepy AM. Characterizing community-level abortion stigma in the United States. Contraception 2021; 104:305-313. [PMID: 33789081 DOI: 10.1016/j.contraception.2021.03.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Estimate community-level abortion stigma among U.S. adults and characterize factors associated with high stigma and less favorable opinions toward policies supportive of abortion care. STUDY DESIGN We recruited respondents (U.S. adults, English-speaking) from a nationally representative, probability-based online panel in December 2018. We used multivariable logistic regression to identify factors associated with high abortion stigma using the Community Attitudes Abortion Scale (CAAS), a Reproductive Events and Experiences Scale (REES) subscale, and a Community Level Abortion Stigma Scale (CLASS) subscale. We measured favorability toward policies supportive of abortion care using widely used polling questions. RESULTS Of 1800 eligible individuals contacted, 984 opened the invitation (54.6%) and 886 (90%) completed the survey. The majority demonstrated midrange stigma scores on all three scales. Increased likelihood of high stigma measured by CAAS was demonstrated among individuals reporting Catholic (OR 2.97, 95%CI 1.49-5.91) and Evangelical or Protestant religion (OR 4.78, 95%CI 2.53-9.00) compared to no religion, and Republican (OR 11.56, 95%CI 6.21-21.52) and Independent political affiliation (5.80, 95%CI, 3.17-10.60) compared to Democratic. Similar trends were seen with REES. Measured by CLASS, we found high stigma in Catholics compared to those with no religion (OR 1.91, 95%CI 1.09-3.32) and Blacks compared to Whites (OR 1.66, 95%CI 1.02-2.68). Identifying as Catholic, Evangelical or Protestant, and Republican were associated with holding less favorable opinions toward policies supportive of abortion care. Identifying as Catholic was the only characteristic associated with high stigma across all measures. CONCLUSIONS Across multiple measurement tools, factors associated with high stigma and less favorable opinions toward policies supportive of abortion care include Catholic, Evangelical or Protestant religion and Republican political affiliation. IMPLICATIONS Multiple measures are needed to fully understand the extent of and characteristics associated with community-level abortion stigma. Religion and political identity are frequently associated with high stigma. Understanding these relationships may aid in developing interventions to decrease stigma and in turn reduce barriers to abortion care.
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Affiliation(s)
- Abigail S Cutler
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA.
| | - Lisbet S Lundsberg
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Marney A White
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Nancy L Stanwood
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Aileen M Gariepy
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
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Twenty years of the Ryan Residency Training Program. Contraception 2021; 103:287-290. [PMID: 33545127 DOI: 10.1016/j.contraception.2021.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 01/22/2021] [Accepted: 01/27/2021] [Indexed: 11/20/2022]
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Swartz JJ, Rowe C, Morse JE, Bryant AG, Stuart GS. Women's knowledge of their state's abortion regulations. A national survey. Contraception 2020; 102:318-326. [PMID: 32771370 PMCID: PMC7409738 DOI: 10.1016/j.contraception.2020.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 07/31/2020] [Accepted: 08/01/2020] [Indexed: 11/28/2022]
Abstract
Objectives States vary significantly in their regulation of abortion. Misinformation about abortion is pervasive and propagated by state-mandated scripts that contain abortion myths. We sought to investigate women’s knowledge of abortion laws in their state. Our secondary objective was to describe women’s ability to discern myths about abortion from facts about abortion. Study design This was a cross-sectional study of English- and Spanish-speaking women aged 18–49 in the United States. We enrolled members of the GfK KnowledgePanel, a probability-based, nationally-representative online sample. Our primary outcome was the proportion of correct answers to 12 questions about laws regulating abortion in a respondent’s state. We asked five questions about common abortion myths. We used descriptive statistics to characterize performance on these measures and bivariate and multivariate modeling to identify risk factors for poor knowledge of state abortion laws. Results Of 2223 women contacted, 1057 (48%) completed the survey. The mean proportion of correct answers to 12 law questions was 18% (95% CI 17–20%). For three of five assessed myths, women endorsed myths about abortion over facts. Those who believe abortion should be illegal (aOR 2.18, CI 1.40–3.37), and those living in states with neutral or hostile state policies toward abortion (neutral aOR 1.99, CI 1.34–2.97; hostile aOR 1.6, CI 1.07–2.36) were at increased odds of poor law knowledge. Conclusions Women had low levels of knowledge about state abortion laws and commonly endorse abortion myths. Women’s knowledge of their state’s abortion laws was associated with personal views about abortion and their state policy environment. Implications Supporters of reproductive rights can use these results to show policy makers that their constituents are unlikely to know about laws being passed that may profoundly affect them. These findings underscore the potential benefit in correcting widely-held, medically-inaccurate beliefs about abortion so opinions about laws can be based on fact.
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Affiliation(s)
- Jonas J Swartz
- Division of Women's Community and Population Health, Department of OB/GYN, Duke University Medical Center, Durham, NC, United States; University of North Carolina School of Medicine, Division of Family Planning, Dept of OBGYN, Chapel Hill, NC, United States.
| | - Carly Rowe
- University of North Carolina School of Medicine, Division of Family Planning, Dept of OBGYN, Chapel Hill, NC, United States
| | - Jessica E Morse
- University of North Carolina School of Medicine, Division of Family Planning, Dept of OBGYN, Chapel Hill, NC, United States
| | - Amy G Bryant
- University of North Carolina School of Medicine, Division of Family Planning, Dept of OBGYN, Chapel Hill, NC, United States
| | - Gretchen S Stuart
- University of North Carolina School of Medicine, Division of Family Planning, Dept of OBGYN, Chapel Hill, NC, United States
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Abstract
The changing political landscape has had a significant impact on abortion training in the United States. Access to training in medical and surgical abortion has been improving over the past several decades, though significant barriers exist in training providers adequately. We sought to evaluate access to abortion training to providers, including obstetrician-gynecologists, family practice physicians, and advanced practice providers. Training in contraception, miscarriage management, medication abortion and surgical abortion procedures is a requirement for Obstetrics and Gynecology residents. Limited information exists about the details of residency training, though larger percentages of graduating residents are reporting access to comprehensive family planning training. Initiatives by groups such as Medical Students for Choice and the Kenneth J. Ryan Program have greatly improved access to abortion training by increasing opportunities for resident involvement. Abortion training opportunities exist for Family Medicine residents and advanced practice clinicians, though this training is not mandated and as such, often not standardized. In light of increasingly restrictive legislation and decreasing numbers of abortion providers, concerns exist about the sustainability of abortion training access. Other noteworthy barriers to provider training include hospital policy, lack of expert faculty, and state laws. Ensuring integrated evidence-based and standardized abortion training is important in maintaining access to a full range of family planning services.
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Affiliation(s)
- Aleksandra Polic
- Department of Obstetrics/Gynecology, University of South Florida Morsani College of Medicine. United States.
| | - Rachel B Rapkin
- Division of Specialists in OB/Gyn, Department of Obstetrics and Gynecology, University of South Florida. United States
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Laws Restricting Access to Abortion Services and Infant Mortality Risk in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17113773. [PMID: 32466506 PMCID: PMC7312072 DOI: 10.3390/ijerph17113773] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/18/2020] [Accepted: 05/20/2020] [Indexed: 01/26/2023]
Abstract
Objectives: Since the US Supreme Court′s 1973 Roe v. Wade decision legalizing abortion, states have enacted laws restricting access to abortion services. Previous studies suggest that restricting access to abortion is a risk factor for adverse maternal and infant health. The objective of this investigation is to study the relationship between the type and the number of state-level restrictive abortion laws and infant mortality risk. Methods: We used data on 11,972,629 infants and mothers from the US Cohort Linked Birth/Infant Death Data Files 2008–2010. State-level abortion laws included Medicaid funding restrictions, mandatory parental involvement, mandatory counseling, mandatory waiting period, and two-visit laws. Multilevel logistic regression was used to determine whether type or number of state-level restrictive abortion laws during year of birth were associated with odds of infant mortality. Results: Compared to infants living in states with no restrictive laws, infants living in states with one or two restrictive laws (adjusted odds ratio (AOR) = 1.08; 95% confidence interval [CI] = 0.99–1.18) and those living in states with 3 to 5 restrictive laws (AOR = 1.10; 95% CI = 1.01–1.20) were more likely to die. Separate analyses examining the relationship between parental involvement laws and infant mortality risk, stratified by maternal age, indicated that significant associations were observed among mothers aged ≤19 years (AOR = 1.09, 95% CI = 1.00–1.19), and 20 to 25 years (AOR = 1.10, 95% CI = 1.03–1.17). No significant association was observed among infants born to older mothers. Conclusion: Restricting access to abortion services may increase the risk for infant mortality.
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Zahedi-Spung LD, Carter EB, López J, Woolfolk C, Macones GA, Stout M. What role should maternal-fetal medicine physicians play in the era of abortion restriction? Am J Obstet Gynecol MFM 2020; 2:100126. [PMID: 33345872 DOI: 10.1016/j.ajogmf.2020.100126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/03/2020] [Accepted: 04/08/2020] [Indexed: 11/15/2022]
Abstract
In 2019, a total of 25 abortion bans were signed into law by states in the Southeast and Midwest. As of May 2019, 33 states have passed laws restricting or limiting abortion services, including "trigger laws" that make abortion illegal in the event that Roe v. Wade is overturned. In addition, 9 states have passed extreme abortion laws, such as making abortion illegal early in gestation (as early as 6-8 weeks' gestation), which are all currently enjoined and not in effect. The Society for Maternal-Fetal Medicine, American College of Obstetricians and Gynecologists, and Society of Family Planning agree that access to abortion is essential to women's health and oppose legislation that directly affects the patient-physician relationship. It is time for maternal-fetal medicine physicians to play a more active role in the fight for abortion access. A 2012 study of maternal-fetal medicine physicians found only 31% of respondents performed dilation and evacuation for termination of pregnancies, predominantly based on whether the provider was trained in dilation and evacuation procedures during fellowship. We performed a 2018 survey of all maternal-fetal medicine fellows and program directors and found that more than two-thirds (62 of 90 [68.9%]) of fellows desire dilation and evacuation training; however, only 9 of 39 (23.1%) program directors believe dilation and evacuation training should be required. The maternal-fetal medicine community is well positioned to improve access to abortion services in the United States by prioritizing dilation and evacuation training for fellows and actively participating in reproductive health advocacy.
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Affiliation(s)
- Leilah D Zahedi-Spung
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO.
| | - Ebony B Carter
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Julia López
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Candice Woolfolk
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - George A Macones
- Dell School of Medicine, University of Texas in Austin, Austin, TX
| | - Molly Stout
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO
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Blackwell S, Louis JM, Norton ME, Lappen JR, Pettker CM, Kaimal A, Landy U, Edelman A, Teal S, Landis R. Reproductive services for women at high risk for maternal mortality: a report of the workshop of the Society for Maternal-Fetal Medicine, the American College of Obstetricians and Gynecologists, the Fellowship in Family Planning, and the Society of Family Planning. Am J Obstet Gynecol 2020; 222:B2-B18. [PMID: 32252942 DOI: 10.1016/j.ajog.2019.12.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Krieger N. Measures of Racism, Sexism, Heterosexism, and Gender Binarism for Health Equity Research: From Structural Injustice to Embodied Harm-An Ecosocial Analysis. Annu Rev Public Health 2019; 41:37-62. [PMID: 31765272 DOI: 10.1146/annurev-publhealth-040119-094017] [Citation(s) in RCA: 169] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Racism. Sexism. Heterosexism. Gender binarism. Together, they comprise intimately harmful, distinct, and entangled societal systems of self-serving domination and privilege that structure the embodiment of health inequities. Guided by the ecosocial theory of disease distribution, I synthesize key features of the specified "isms" and provide a measurement schema, informed by research from both the Global North and the Global South. Metrics discussed include (a) structural, including explicit rules and laws, nonexplicit rules and laws, and area-based or institutional nonrule measures; and (b) individual-level (exposures and internalized) measures, including explicit self-report, implicit, and experimental. Recommendations include (a) expanding the use of structural measures to extend beyond the current primary emphasis on psychosocial individual-level measures; (b) analyzing exposure in relation to both life course and historical generation; (c) developing measures of anti-isms; and (d) developing terrestrially grounded measures that can reveal links between the structural drivers of unjust isms and their toll on environmental degradation, climate change, and health inequities.
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Affiliation(s)
- Nancy Krieger
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts 02115, USA;
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Singh A. The dangers of parental consent start before obstetric care. Am J Obstet Gynecol 2019; 220:408. [PMID: 30576663 DOI: 10.1016/j.ajog.2018.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 12/12/2018] [Indexed: 10/27/2022]
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