Homelessness, housing instability, and abortion outcomes at an urban abortion clinic in the United States

Safe abortion service utilization and associated factors among insecurely housed women who experienced abortion in southwest Ethiopia, 2021: A community-based cross-sectional study

Background

Insecurely housed women are more vulnerable to physical and mental health issues than the general population, making access to a safe abortion more difficult. Though Ethiopia has a penal code regarding safe abortion care, there has been a dearth of studies investigating the safe abortion care practice among those insecurely housed women. Thus, this study aimed at assessing the magnitude of safe abortion service uptake and its determinants among insecurely housed women who experienced abortion in southwest Ethiopia.

Methods

A community-based cross-sectional study was conducted in three towns in southwest Ethiopia from May 20-July 20, 2021. A total of 124 street-involved women were included in the study. They were selected by snowball sampling technique and data was collected through a face-to-face interview. The data were entered into Epi-data Version 3.1 and exported to SPSS 21 for analysis. A bivariable and multivariable logistic regression analyses were performed to determine the association of independent variables with the outcome variable. The level of significance was determined at a p-value <0.05. To determine whether the model is powerful enough in identifying any significant effects that do exist on the dependent variables, a power analysis was performed via a Post-hoc Statistical Power Calculator for Multiple Regressions.

Results

The magnitude of safe abortion service utilization among insecurely housed women was found to be 27.9% [95% CI: 20.1, 34.2]. Average daily income [AOR:3.83, 95% CI: 1.38, 10.60], knowledge of safe abortion services [AOR:3.94; 95% CI: 1.27,9.24], and affordability of the service [AOR: 3.27; 95% CI:1.87, 8.41] were identified as significant predictors of safe abortion service among insecurely housed women.

Conclusion and recommendation

The magnitude of safe abortion service utilization among insecurely housed women in the study area was low. The respective town health offices and health care providers at the facility level should strive to improve awareness about safe abortion service’s legal framework, and its availability. In addition, a concerted effort is needed from local administrators, NGOs, and healthcare managers to engage those insecurely housed women in income-generating activities that allow them to access safe abortion and other reproductive and maternal health services.

Undue burdens created by the Texas Abortion Law for vulnerable pregnant women

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.

Health status of women affected by homelessness: A cluster of in concreto human rights violations and a time for action

Health problems of women experiencing homelessness are driven either from the usual background characteristics of this population, or from the homeless lifestyle. Apart from poverty and unemployment, transition to homelessness is often associated with substance abuse, history of victimization, stress, poor mental health and human immunodeficiency virus (HIV). Water insecurity can undermine bodily hygiene and dental health, posing a greater risk of dehydration and opportunistic infections. Exposure to extreme environmental conditions like heat waves and natural disasters increases morbidity, accelerates aging, and reduces life expectancy. Nutrition-wise, a high prevalence of food insecurity, obesity, and micronutrient deficiencies are apparent due to low diet quality and food waste. Poor hygiene, violence, and overcrowding increase the susceptibility of these women to communicable diseases, including sexually transmitted ones and COVID-19. Furthermore, established cardiovascular disease and diabetes mellitus are often either undertreated or neglected, and their complications are more widespread than in the general population. In addition, lack of medical screening and contraception non-use induce a variety of reproductive health issues. All these health conditions are tightly related to violations of human rights in this population, including the rights to housing, water, food, reproduction, health, work, and no discrimination. Thus, the care provided to women experiencing homelessness should be optimized at a multidimensional level, spanning beyond the provision of a warm bed, to include access to clean water and sanitation, psychological support and stress-coping strategies, disease management and acute health care, food of adequate quality, opportunities for employment and support for any minor dependants.