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Chervenak FA, Moreno JD, McLeod-Sordjan R, Bornstein E, Katz A, Pollet SL, Combs A, De Four Jones M, Lewis D, Bachmann G, Gordon MR, Warman A, Grünebaum A. Addressing challenges related to the professional practice of abortion post-Roe. Am J Obstet Gynecol 2024; 230:532-539. [PMID: 37914062 DOI: 10.1016/j.ajog.2023.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 11/03/2023]
Abstract
The landmark Roe vs Wade Supreme Court decision in 1973 established a constitutional right to abortion. In June 2022, the Dobbs vs Jackson Women's Health Organization Supreme Court decision brought an end to the established professional practice of abortion throughout the United States. Rights-based reductionism and zealotry threaten the professional practice of abortion. Rights-based reductionism is generally the view that moral or ethical issues can be reduced exclusively to matters of rights. In relation to abortion, there are 2 opposing forms of rights-based reductionism, namely fetal rights reductionism, which emphasizes the rights for the fetus while disregarding the rights and autonomy of the pregnant patient, and pregnant patient rights reductionism, which supports unlimited abortion without regards for the fetus. The 2 positions are irreconcilable. This article provides historical examples of the destructive nature of zealotry, which is characterized by extreme devotion to one's beliefs and an intolerant stance to opposing viewpoints, and of the importance of enlightenment to limit zealotry. This article then explores the professional responsibility model as a clinically ethically sound approach to overcome the clashing forms of rights-based reductionism and zealotry and to address the professional practice of abortion. The professional responsibility model refers to the ethical and professional obligations that obstetricians and other healthcare providers have toward pregnant patients, fetuses, and the society at large. It provides a more balanced and nuanced approach to the abortion debate, avoiding the pitfalls of reductionism and zealotry, and allows both the rights of the woman and the obligations to pregnant and fetal patients to be considered alongside broader ethical, medical, and societal implications. Constructive and respectful dialogue is crucial in addressing diverse perspectives and finding common ground. Embracing the professional responsibility model enables professionals to manage abortion responsibly, thereby prioritizing patients' interests and navigating between absolutist viewpoints to find balanced ethical solutions.
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Affiliation(s)
- Frank A Chervenak
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY
| | | | | | - Eran Bornstein
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY
| | - Adi Katz
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY
| | - Susan L Pollet
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY
| | - Adriann Combs
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY
| | | | - Dawnette Lewis
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY
| | - Gloria Bachmann
- Robert Wood Johnson University Hospital New Brunswick, New Brunswick, NJ
| | | | - Ashley Warman
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY
| | - Amos Grünebaum
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY.
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Chervenak F, McLeod-Sordjan R, Moreno JD, Pollet S, Bornstein E, Dudenhausen J, Grünebaum A. The importance of professional responsibility and fetal viability in the management of abortion. J Perinat Med 2024; 52:249-254. [PMID: 38342778 DOI: 10.1515/jpm-2023-0503] [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] [Received: 12/03/2023] [Accepted: 01/02/2024] [Indexed: 02/13/2024]
Abstract
In June 2022, the Dobbs v. Jackson Women's Health Organization Supreme Court decision ended the constitutional right to the professional practice of abortion throughout the United States. The removal of the constitutional right to abortion has significantly altered the practice of obstetricians and gynecologists across the US. It potentially increases risks to pregnant patients, leads to profound changes in how physicians can provide care, especially in states with strict bans or gestational limits to abortion, and has introduced personal challenges, including moral distress and injury as well as legal risks for patients and clinicians alike. The professional responsibility model is based on the ethical concept of medicine as a profession and has been influential in shaping medical ethics in the field of obstetrics and gynecology. It provides the framework for the importance of ethical and professional conduct in obstetrics and gynecology. Viability marks a stage where the fetus is a patient with a claim to access to medical care. By allowing unrestricted abortions past this stage without adequate justifications, such as those concerning the life and health of the pregnant individual, or in instances of serious fetal anomalies, the states may not be upholding the equitable ethical consideration owed to the fetus as a patient. Using the professional responsibility model, we emphasize the need for nuanced, evidence-based policies that allow abortion management prior to viability without restrictions and allow abortion after viability to protect the pregnant patient's life and health, as well as permitting abortion for serious fetal anomalies.
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Affiliation(s)
- Frank Chervenak
- Northwell, New Hyde Park, NY, USA
- Department of Obstetrics and Gynecology, Lenox Hill Hospital; Zucker School of Medicine;Northwell, 2000 Marcus Ave, Suite 300, New Hyde Park, NY, USA
| | - Renee McLeod-Sordjan
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hofstra Northwell School of Nursing and Physician Assistant Studies, Northwell Health, New York, NY, USA
| | | | - Susan Pollet
- Northwell, New Hyde Park, NY, USA
- Department of Obstetrics and Gynecology, Lenox Hill Hospital; Zucker School of Medicine;Northwell, 2000 Marcus Ave, Suite 300, New Hyde Park, NY, USA
| | - Eran Bornstein
- Northwell, New Hyde Park, NY, USA
- Department of Obstetrics and Gynecology, Lenox Hill Hospital; Zucker School of Medicine;Northwell, 2000 Marcus Ave, Suite 300, New Hyde Park, NY, USA
| | - Joachim Dudenhausen
- Northwell, New Hyde Park, NY, USA
- Department of Obstetrics and Gynecology, Lenox Hill Hospital; Zucker School of Medicine;Northwell, 2000 Marcus Ave, Suite 300, New Hyde Park, NY, USA
- Department of Obstetrics, Charité - University Medicine Berlin, Berlin, Germany
| | - Amos Grünebaum
- Northwell, New Hyde Park, NY, USA
- Department of Obstetrics and Gynecology, Lenox Hill Hospital; Zucker School of Medicine;Northwell, 2000 Marcus Ave, Suite 300, New Hyde Park, NY, USA
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Gautham I, Coverdale J, Nguyen PT, Gordon MR. Clinical and Advocacy Implications of the Dobbs vs. Jackson Women's Health Organization Ruling on Trafficked Persons. Violence Against Women 2024:10778012241231779. [PMID: 38425289 DOI: 10.1177/10778012241231779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
The United States Supreme Court decision on the case of Dobbs vs. Jackson Women's Health Organization abolished federal protections of abortion, leaving abortion legislation at the discretion of individual states. Trafficked persons are a population especially vulnerable to the impacts of this ruling. Because there is no existing literature describing the effects of restrictive abortion legislation on this group, we described some of the potential consequences of restrictive abortion laws for sex and labor trafficked persons, based on real case examples. We describe steps that should be taken to sufficiently protect and support pregnant trafficked women in relation to the Dobbs law.
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Affiliation(s)
- Ila Gautham
- School of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - John Coverdale
- School of Medicine, Baylor College of Medicine, Houston, TX, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
- Anti-Human Trafficking Program, Baylor College of Medicine, Houston, TX, USA
| | - Phuong T Nguyen
- School of Medicine, Baylor College of Medicine, Houston, TX, USA
- Anti-Human Trafficking Program, Baylor College of Medicine, Houston, TX, USA
| | - Mollie R Gordon
- School of Medicine, Baylor College of Medicine, Houston, TX, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Anti-Human Trafficking Program, Baylor College of Medicine, Houston, TX, USA
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4
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Chen R, Gordon M, Chervenak F, Coverdale J. Addressing Moral Distress After Dobbs v. Jackson Women's Health Organization : A Professional Virtues-Based Approach. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:12-15. [PMID: 37816216 DOI: 10.1097/acm.0000000000005476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
ABSTRACT The June 2022 U.S. Supreme Court decision in Dobbs v. Jackson Women's Health Organization abolished federal protections for reproductive choice. In states where subsequent legislation has restricted or banned access to abortion services, physicians and trainees are prevented from providing ethically justified evidence-based care when patients with previable pregnancies are seeking an abortion. Pregnant patients' vulnerabilities, stress, and the undue burden that they experience when prevented from acting in accordance with their reproductive decision-making can evoke negative emotional consequences, including moral distress in clinicians. Moral distress occurs when clinicians feel a moral compulsion to act a certain way but cannot do so because of external constraints, including being hindered by state laws that curtail practicing in line with professional standards on reproductive health care. Moral distress has the potential to subvert prudent clinical judgment. The authors provide recommendations for managing moral distress in these circumstances based on the professional virtues. The fundamental professional virtues of integrity, compassion, self-effacement, self-sacrifice, and humility inform the management of moral distress and how to respond thoughtfully and compassionately, without over-identification or indifference to the plight of patients denied abortions. The authors also discuss the role of academic leaders and medical educators in cultivating a virtue-based professional culture at the forefront of clinical and educational processes in a post- Dobbs world.
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Barnes-Davis ME, Cortezzo DE. The patient/physician relationship in a post-Roe world: a neonatologist viewpoint. J Perinatol 2023; 43:968-972. [PMID: 36528653 PMCID: PMC10325948 DOI: 10.1038/s41372-022-01583-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/02/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
The Supreme Court ruling in Dobbs v. Jackson Women's Health Organization has far-reaching implications that go beyond the practice of obstetrics and gynecology. The ruling and subsequent laws and bills impact many specialties and have implications for healthcare as a whole. The rapidly changing medicolegal landscape has significant bearings on and implications for the fields of neonatology and pediatrics. These rulings have an impact on the patient-physician relationship and a shared decision-making approach to care. Furthermore, there are significant sequelae of forced birth and resuscitation. This review provides a clinically relevant update of the current medicolegal landscape and applications to the practice of neonatology.
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Affiliation(s)
- Maria E Barnes-Davis
- Division of Neonatal and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, USA, OH.
| | - DonnaMaria E Cortezzo
- Division of Neonatal and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Anesthesiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Pain and Palliative Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Ferro HP, Williams K, Holbrook DS, O'Conor KJ. Disproportionate impact of abortion restriction: Implications for emergency department clinicians. Am J Emerg Med 2023; 69:160-166. [PMID: 37121065 DOI: 10.1016/j.ajem.2023.04.022] [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: 12/20/2022] [Revised: 04/11/2023] [Accepted: 04/18/2023] [Indexed: 05/02/2023] Open
Abstract
Individuals experiencing intimate partner violence (IPV) and/or human trafficking (HT) are at increased risk of severe health consequences as a result of legislation criminalizing and/or restricting abortion, which is expected to increase as a result of the Supreme Court decision Dobbs v. Jackson. These risks are further stratified by race, socioeconomics, and other marginalizing demographic attributes. IPV and HT introduce barriers to maintaining physical and mental health, due to control of access to transportation and funds by the abuser, fear of retribution for seeking healthcare, and other barriers. Individuals experiencing IPV or HT often lack reproductive autonomy, as a result of facing reproductive coercion at the hands of their abusers. Following the Dobbs decision, these vulnerable patient populations will face further limitations on their reproductive autonomy and increased obstacles to obtaining an abortion if they medically need or desire one. This will likely result in more patients presenting to the emergency department due to complications from unsafe or unsupervised self-managed abortions, as well as patients being reluctant to report having obtained an unlawful abortion due to fear of legal consequences. This is particularly relevant to individuals experiencing IPV and HT, as they may be more likely to use these methods for obtaining an abortion due to numerous barriers. Emergency medicine clinicians are vital in providing care to these patients, as they frequently present to emergency departments. A multi-pronged approach to better support these patients is essential, involving an increased index of suspicion for IPV, HT or the complications of unsupervised abortion, improved organizational structures, specialized training for staff, improved screening methods, reflection on implicit bias, and recommendations for mindful documentation and legal considerations.
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Affiliation(s)
- Haleigh P Ferro
- Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21287, United States.
| | - Kelly Williams
- Johns Hopkins Medicine, 1800 Orleans St, Baltimore, MD 21287, United States.
| | - Debra S Holbrook
- Mercy Medical Center, 345 St. Paul Pl, Baltimore, MD 21202, United States.
| | - Katie J O'Conor
- Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21287, United States.
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Stephenson-Famy A, Sonn T, Baecher-Lind L, Bhargava R, Chen KT, Fleming A, Kang Morgan H, Morosky CM, Schaffir JA, Madani Sims S, Sutton JM, Royce CS. The Dobbs Decision and Undergraduate Medical Education: The Unintended Consequences and Strategies to Optimize Reproductive Health and a Competent Workforce for the Future. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:431-435. [PMID: 36347017 DOI: 10.1097/acm.0000000000005083] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The June 2022 U.S. Supreme Court decision on Dobbs v Jackson Women's Health Organization resulted in state-specific differences in abortion care access across the country. The primary concern in the obstetrics and gynecology education community has been the impact on resident and fellowship training programs. However, the impact on undergraduate medical education and the broad implications for future generations of physicians are crucial to address. It is estimated that 48% of matriculants to MD-granting medical schools will receive their medical education in the 26 states with significant abortion restrictions or bans. Undergraduate medical educators need to continue to adequately teach the basic science, clinical care, and population health outcomes of reproductive medicine, including pregnancy and abortion. In addition, students in states with more restrictions on abortion will have less or no clinical exposure, and those in states with few restrictions may be excluded due to overcrowding of learners from restricted states. Students' own health care also needs to be considered, as access to abortion care for themselves or their partners may create applicant pool demographic shifts by state as applicants consider options for where to pursue their medical education. It is important to ensure that teaching of foundational science of pregnancy, abortion, and reproductive health continues throughout the United States. Undergraduate and graduate medical educators will need to closely monitor the downstream impact of decreased clinical exposure of abortion. Further study of the personal health impact of abortion care access for medical students and awareness of the changing applicant pool demographics by state is needed.
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Affiliation(s)
- Alyssa Stephenson-Famy
- A. Stephenson-Famy is associate professor, Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington
| | - Tammy Sonn
- T. Sonn is professor and vice chair for education, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Laura Baecher-Lind
- L. Baecher-Lind is professor and dean for educational affairs, Tufts School of Medicine, Boston, Massachusetts
| | - Rashmi Bhargava
- R. Bhargava is assistant professor and provincial undergraduate chair, Department of Obstetrics and Gynecology, University of Saskatchewan College of Medicine, Regina, Saskatchewan, Canada
| | - Katherine T Chen
- K.T. Chen is professor and system vice chair of education, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Angela Fleming
- A. Fleming is residency program director, Department of Obstetrics and Gynecology, Beaumont Hospital, Beaumont Health, Farmington Hills, Michigan
| | - Helen Kang Morgan
- H. Kang Morgan is professor, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Christopher M Morosky
- C.M. Morosky is associate professor and clerkship director, Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Jonathan A Schaffir
- J.A. Schaffir is professor, Department of Obstetrics and Gynecology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Shireen Madani Sims
- S. Madani Sims is professor and vice chair of education, Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, Florida
| | - Jill M Sutton
- J.M. Sutton is clinical associate professor and director of undergraduate education, Department of Obstetrics and Gynecology, Brody School of Medicine at East Carolina University, Greenville, North Carolina
| | - Celeste S Royce
- C.S. Royce is assistant professor, Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, and director, undergraduate medical education, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Jung C, Oviedo J, Nippita S. Abortion Care in the United States - Current Evidence and Future Directions. NEJM EVIDENCE 2023; 2:EVIDra2200300. [PMID: 38320010 DOI: 10.1056/evidra2200300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Abortion Care in the United StatesAbortion services are a vital component of reproductive health care. Jung and colleagues review medication abortion and procedural abortion as well as implications of increasing restrictions on access in the United States.
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Affiliation(s)
- Christina Jung
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine
| | - Johana Oviedo
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine
| | - Siripanth Nippita
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine
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9
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Kucukkaya B, Basgol S. The effect of perceived spousal support on childbirth self-efficacy on pregnant women in turkey. BMC Pregnancy Childbirth 2023; 23:173. [PMID: 36915041 PMCID: PMC10012433 DOI: 10.1186/s12884-023-05508-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/07/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Spousal support during pregnancy reduces the anxiety and stress of the pregnant women and increases the ability to cope with the problems experienced by the pregnant women. The study aimed to examine the effect of perceived spousal support on childbirth self-efficacy on pregnant women in Turkey. METHODS This cross-sectional exploratory study was conducted on 524 pregnant women who volunteered to participate in the research by approving the shared online survey and distributed by sharing the online questionnaire created by the researchers on social media (such as Facebook and Instagram) forums or group pages between 20 June and 27 July 2022. Data were collected with an e-questionnaire including The Information Form prepared by examining the literature from the pregnant women who volunteered to participate, the Spouse Support Scale measures the perceived spousal support level and consists of 27 questions, and the Childbirth Self-Efficacy Scale measures women's self-confidence in childbirth and their ability to cope and consists of 32 questions in the study. RESULTS The mean age of the pregnant women was 29.99 (5.62) and the mean week of gestation was 25.93 (7.72). It was determined that 11.5% of the pregnant women were related to their spouses, 78.2% were married voluntarily, 86.5% had knowledge about birth, and 74.6% had a planned pregnancy. The Spouse Support Scale (SSS) total score average was 66.06 (19.82), the emotional support sub-dimension mean score of SSS was 22.03 (6.63), the material support and information support sub-dimension mean score was 17.17 (5.12), appreciation support sub-dimension mean score was 19.52 (5.90) and social interest support sub-dimension mean score was 21.98 (10.18), while the total mean score of the Childbirth Self Efficacy Scale (CBSES) was 234.20 (108.14), CBSES's result expectation sub-dimension mean score was 116.98 (54.13), and proficiency expectation sub-dimension mean score was 117.22 (54.07). A statistically significant correlation was found between the total and sub-dimension mean scores of CBSES and the mean scores of the total and sub-dimension SSS in pregnant women (p < .001). CONCLUSION It was determined that perceived spousal support has an effect on birth self-efficacy in pregnant women in Turkey. Obstetrics nurses and midwives should support the spousal support and birth self-efficacy of pregnant women during pregnancy follow-up and delivery.
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Affiliation(s)
- Burcu Kucukkaya
- Department of Women Health and Diseases Nursing, Nursing Department, Trakya University, Faculty of Health Sciences, Edirne, Turkey. .,Trakya University Rectorate, 22030 Balkan Campus, Edirne, Turkey.
| | - Sukran Basgol
- Midwifery Department, Ondokuz Mayis University, Faculty of Health Sciences, Samsun, Turkey
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Stein RA, Katz A, Chervenak FA. The far-reaching impact of abortion bans: reproductive care and beyond. EUR J CONTRACEP REPR 2023; 28:23-27. [PMID: 36369860 DOI: 10.1080/13625187.2022.2140008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
On 24 June 2022, the US Supreme Court overturned Roe v. Wade, a 49-year-old precedent that provided federal constitutional protection for abortions up to the point of foetal viability, returning jurisdiction to the individual states. Restrictions that came into effect automatically in several states, and are anticipated in others, will severely limit access to abortions in approximately half of the US. Even though every state allows for exceptions to the abortion bans, in some instances these exceptions can be used to preserve the health of a pregnant patient, while in other instances, only to preserve their life. The vague and confusing nature of the abortion ban exceptions threatens to compromise the standard of care for patients with pregnancy complications that are distinct from abortions, such as nonviable pregnancies, miscarriages, and ectopic pregnancies. Additionally, we envision challenges for the treatment of women with certain autoimmune conditions, pregnant cancer patients, and patients contemplating preimplantation genetic diagnosis as part of assisted reproductive technologies. The abortion ban exceptions will impact and interfere with the medical care of pregnant and non-pregnant patient populations alike and are poised to create a medical and public health crisis unlike any other one from the recent past.
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Affiliation(s)
- Richard A Stein
- Department of Chemical and Biomolecular Engineering, NYU Tandon School of Engineering, Brooklyn, NY, USA
| | - Adi Katz
- Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Department of Obstetrics and Gynecology, Lenox Hill Hospital, New York, NY, USA
| | - Frank A Chervenak
- Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Department of Obstetrics and Gynecology, Lenox Hill Hospital, New York, NY, USA
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11
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Coverdale J, Gordon MR, Beresin EV, Guerrero APS, Louie AK, Balon R, Morreale MK, Aggarwal R, Brenner AM. Access to Abortion After Dobbs v. Jackson Women's Health Organization: Advocacy and a Call to Action for the Profession of Psychiatry. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2023; 47:1-6. [PMID: 36369427 PMCID: PMC9652041 DOI: 10.1007/s40596-022-01729-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
| | | | | | | | | | | | | | | | - Adam M Brenner
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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12
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Jacobs JW, Fabbri S, Woo JS, Booth GS. Overturning Roe v. Wade: Medical and Legal Impacts on Blood Transfusion in the Obstetric Population. J Womens Health (Larchmt) 2023; 32:129-131. [PMID: 36576800 DOI: 10.1089/jwh.2022.0441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Jeremy W Jacobs
- Division of Transfusion Medicine, Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Stefka Fabbri
- Department of Obstetrics and Gynecology, Denver Health Medical Center, Denver, Colorado, USA
| | - Jennifer S Woo
- Department of Pathology, City of Hope National Medical Center, Duarte, California, USA
| | - Garrett S Booth
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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13
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Crable EL, Lengnick-Hall R, Stadnick NA, Moullin JC, Aarons GA. Where is "policy" in dissemination and implementation science? Recommendations to advance theories, models, and frameworks: EPIS as a case example. Implement Sci 2022; 17:80. [PMID: 36503520 PMCID: PMC9742035 DOI: 10.1186/s13012-022-01256-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Implementation science aims to accelerate the public health impact of evidence-based interventions. However, implementation science has had too little focus on the role of health policy - and its inseparable politics, polity structures, and policymakers - in the implementation and sustainment of evidence-based healthcare. Policies can serve as determinants, implementation strategies, the evidence-based "thing" to be implemented, or another variable in the causal pathway to healthcare access, quality, and patient outcomes. Research describing the roles of policy in dissemination and implementation (D&I) efforts is needed to resolve persistent knowledge gaps about policymakers' evidence use, how evidence-based policies are implemented and sustained, and methods to de-implement policies that are ineffective or cause harm. Few D&I theories, models, or frameworks (TMF) explicitly guide researchers in conceptualizing where, how, and when policy should be empirically investigated. We conducted and reflected on the results of a scoping review to identify gaps of existing Exploration, Preparation, Implementation, and Sustainment (EPIS) framework-guided policy D&I studies. We argue that rather than creating new TMF, researchers should optimize existing TMF to examine policy's role in D&I. We describe six recommendations to help researchers optimize existing D&I TMF. Recommendations are applied to EPIS, as one example for advancing TMF for policy D&I. RECOMMENDATIONS (1) Specify dimensions of a policy's function (policy goals, type, contexts, capital exchanged). (2) Specify dimensions of a policy's form (origin, structure, dynamism, outcomes). (3) Identify and define the nonlinear phases of policy D&I across outer and inner contexts. (4) Describe the temporal roles that stakeholders play in policy D&I over time. (5) Consider policy-relevant outer and inner context adaptations. (6) Identify and describe bridging factors necessary for policy D&I success. CONCLUSION Researchers should use TMF to meaningfully conceptualize policy's role in D&I efforts to accelerate the public health impact of evidence-based policies or practices and de-implement ineffective and harmful policies. Applying these six recommendations to existing D&I TMF advances existing theoretical knowledge, especially EPIS application, rather than introducing new models. Using these recommendations will sensitize researchers to help them investigate the multifaceted roles policy can play within a causal pathway leading to D&I success.
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Affiliation(s)
- Erika L Crable
- Department of Psychiatry, University of California, La Jolla, San Diego, CA, 92093, USA.
- Child and Adolescent Services Research Center, San Diego, CA, USA.
- UC San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, La Jolla, San Diego, CA, USA.
| | | | - Nicole A Stadnick
- Department of Psychiatry, University of California, La Jolla, San Diego, CA, 92093, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
- UC San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, La Jolla, San Diego, CA, USA
| | - Joanna C Moullin
- Faculty of Health Sciences, enAble Institute, Curtin University, Perth, WA, Australia
| | - Gregory A Aarons
- Department of Psychiatry, University of California, La Jolla, San Diego, CA, 92093, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
- UC San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, La Jolla, San Diego, CA, USA
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14
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Räsänen J, Gothreau C, Lippert-Rasmussen K. Does overruling Roe discriminate against women (of colour)? JOURNAL OF MEDICAL ETHICS 2022; 48:952-956. [PMID: 36180204 DOI: 10.1136/jme-2022-108504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/16/2022] [Indexed: 06/16/2023]
Abstract
On 24 July 2022, the landmark decision Roe v. Wade (1973), that secured a right to abortion for decades, was overruled by the US Supreme Court. The Court decision in Dobbs v. Jackson Women's Health Organisation severely restricts access to legal abortion care in the USA, since it will give the states the power to ban abortion. It has been claimed that overruling Roe will have disproportionate impacts on women of color and that restricting access to abortion contributes to or amounts to structural racism. In this paper, we consider whether restricting abortion access as a consequence of overruling Roe could be understood as discrimination against women of color (and women in general). We argue that banning abortion is indirectly discriminatory against women of color and directly (but neither indirectly, nor structurally) discriminatory against women in general.
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Affiliation(s)
- Joona Räsänen
- CEPDISC - Centre for the Experimental-Philosophical Study of Discrimination, Department of Political Science, Aarhus University, Aarhus, Denmark
| | - Claire Gothreau
- CEPDISC - Centre for the Experimental-Philosophical Study of Discrimination, Department of Political Science, Aarhus University, Aarhus, Denmark
| | - Kasper Lippert-Rasmussen
- CEPDISC - Centre for the Experimental-Philosophical Study of Discrimination, Department of Political Science, Aarhus University, Aarhus, Denmark
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15
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Hamidi S, Alev C. In vitro models of pre- and post-gastrulation embryonic development. Curr Opin Genet Dev 2022; 77:101985. [PMID: 36244078 DOI: 10.1016/j.gde.2022.101985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/17/2022] [Accepted: 08/24/2022] [Indexed: 01/27/2023]
Abstract
The successful derivation and culture of pluripotent stem cells (PSCs) is tightly connected with the study of embryonic development, and was made largely possible by advances in in vitro fertilization and blastocyst culture during the latter half of the last century [1,2]. Since then, embryonic and induced pluripotent stem cells have been extensively used to derive a plethora of functional cell types in vitro, heavily relying on and utilizing insights into cellular differentiation won from developmental biological studies in model organisms. Excitingly, PSCs are now being increasingly used to reconstitute and analyze complex aspects of mouse and human embryonic development. These bottom-up approaches are starting to provide novel insights into core developmental processes and biological questions and may ultimately help decipher the biological principles that underlie the emergence of form and function during development. This mini review summarizes the latest advances and recent breakthroughs in this rapidly growing field of research on PSC-based in vitro models of early embryonic development.
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Affiliation(s)
- Sofiane Hamidi
- Institute for the Advanced Study of Human Biology (ASHBi), Kyoto University, Kyoto 606-8501, Japan
| | - Cantas Alev
- Institute for the Advanced Study of Human Biology (ASHBi), Kyoto University, Kyoto 606-8501, Japan.
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