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Lands M, Dyer RL, Seymour JW. Sampling strategies among studies of barriers to abortion in the United States: A scoping review of abortion access research. Contraception 2024; 131:110342. [PMID: 38012964 DOI: 10.1016/j.contraception.2023.110342] [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: 02/06/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVES Understanding barriers to abortion care is particularly important post-Dobbs. However, many abortion access studies recruit from abortion-providing facilities, which overlook individuals who do not present for clinic-based care. To our knowledge, no studies have reviewed research recruitment strategies in the literature or considered how they might affect our knowledge of abortion barriers. We aimed to identify populations included and sampling methods used in studies of abortion barriers in the United States. STUDY DESIGN We used a scoping review protocol to search five databases for articles examining US-based individuals' experiences accessing abortion. We included English-language articles published between January 2011 and February 2022. For included studies, we identified the sampling strategy and population recruited. RESULTS Our search produced 2763 articles, of which 71 met inclusion criteria. Half of the included papers recruited participants at abortion-providing facilities (n = 35), while the remainder recruited from online sources (n = 14), other health clinics (n = 10), professional organizations (n = 8), abortion funds (n = 2), community organizations (n = 2), key informants (n = 2), and an abortion storytelling project (n = 1). Most articles (n = 61) reported information from people discussing their own abortions; the rest asked nonabortion seekers (e.g., physicians, genetic counselors, attorneys) about barriers to care. CONCLUSIONS Studies of abortion barriers enroll participants from a range of venues, but the majority recruit people who obtained abortions, and half recruit from abortion clinics. IMPLICATIONS As abortion access becomes constrained and criminalized in the post-Roe context, our findings indicate how investigators might recruit study participants from a variety of settings to fully understand the abortion seeking experience.
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Affiliation(s)
- Madison Lands
- University of Wisconsin Collaborative for Reproductive Equity, Madison, WI, United States.
| | - Rachel L Dyer
- University of Wisconsin Collaborative for Reproductive Equity, Madison, WI, United States; University of Wisconsin Department of Counseling Psychology, Madison, WI, United States
| | - Jane W Seymour
- University of Wisconsin Collaborative for Reproductive Equity, Madison, WI, United States
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Liu SY, Benny C, Grinshteyn E, Ehntholt A, Cook D, Pabayo R. The association between reproductive rights and access to abortion services and mental health among US women. SSM Popul Health 2023; 23:101428. [PMID: 37215399 PMCID: PMC10199416 DOI: 10.1016/j.ssmph.2023.101428] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 05/05/2023] [Accepted: 05/11/2023] [Indexed: 05/24/2023] Open
Abstract
Background This study examines whether living in US states with (1) restrictive reproductive rights and (2) restrictive abortion laws is associated with frequent mental health distress among women. Methods We operationalize reproductive rights using an overall state-level measure of reproductive rights as well as a state-level measure of restrictive abortion laws. We merged data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS) with these state-level exposure variables and other state-level information. We used multilevel logistic regression to assess the relationship between these two measures and the likelihood of reporting 14 or more days of frequent mental health distress. We also tested whether associations differed across race, household income, education, and marital status. Results In the adjusted models, a standard deviation-unit increase in the reproductive rights score was significantly associated with decreased odds of reporting frequent mental health distress (OR = 0.95, 95% CI = 0.91, 0.99). Women in states with very hostile abortion restrictions had higher odds of frequent mental health distress. Associations between state-level abortion restrictions were larger among women 25-34 years old and women with a high school degree. For example, women aged 25-34 years residing in moderate (OR = 1.54, 95% CI = 1.14, 2.04), hostile (OR = 1.59, 95% CI = 1.15, 2.18), and very hostile (OR = 1.29, 95% CI = 1.02, 1.64) states were more likely to report frequent mental health distress than women living in states with less restrictive abortion policies. Conclusion We found the association between state-level restrictions on reproductive rights and abortion access and frequent mental health distress differed by age and socioeconomic status. These results suggest abortion rights restrictions may contribute to mental health inequities among women.
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Affiliation(s)
- Sze Yan Liu
- Department of Public Health, Montclair State University, Normal Avenue, Montclair, NJ, 07043, USA
| | - Claire Benny
- Department of Epidemiology, University of Alberta, Edmonton, Canada
| | - Erin Grinshteyn
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA
| | - Amy Ehntholt
- NYS Office of Mental Health, New York State Psychiatric Institute, New York, NY, USA
| | - Daniel Cook
- School of Public Health, University of Nevada Reno, Reno, NV, USA
| | - Roman Pabayo
- Department of Epidemiology, University of Alberta, Edmonton, Canada
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Assessing psychosocial costs: Ohio patients' experiences seeking abortion care. Contraception 2023; 117:45-49. [PMID: 36087646 DOI: 10.1016/j.contraception.2022.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/24/2022] [Accepted: 08/26/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Existing research has not thoroughly characterized the psychosocial costs associated with seeking abortion care in restrictive states. Our study seeks to fill this gap by analyzing the accounts of Ohio abortion patients from 2018 to 2019. STUDY DESIGN Using inductive and deductive approaches, we analyzed semi-structured in-depth qualitative interviews with 41 Ohio residents who obtained abortion care from one of three clinics in Ohio or Pennsylvania. RESULTS Ohioans seeking abortion care often experienced fear of judgment, interpersonal strain, and stress as a result of efforts to overcome pre-Dobbs financial, geographic, and timing challenges. Those who needed financial assistance or traveled more than an hour generally reported greater exposure to psychosocial costs. CONCLUSIONS Participants in this study incurred a complex set of psychosocial costs. Psychosocial costs often resulted from, or were exacerbated by, the financial, geographic, and time-sensitive burdens that patients experienced seeking care. IMPLICATIONS The psychosocial costs incurred by patients seeking abortion care may be exacerbated in restrictive contexts, especially those who do not have access to insurance coverage for care. Psychosocial costs associated with care seeking are likely to increase as states implement more severe restrictions post-Dobbs. To fully understand abortion costs, researchers must examine costs comprehensively, including both financial and psychosocial costs.
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Woodruff K, Berglas N, Herold S, Roberts SCM. Disseminating Evidence on Abortion Facilities to Health Departments: A Randomized Study of E-mail Strategies. HEALTH COMMUNICATION 2023; 38:61-70. [PMID: 34061693 DOI: 10.1080/10410236.2021.1932109] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Given the politicization of abortion, professionals working in U.S. health departments (HDs) may not be receptive to communications about abortion, despite often regulating abortion facilities. This paper reports results of a randomized, prospective, observational study to test the effects of e-mail language when disseminating evidence on abortion to HD professionals. Our sample was 302 HD employees who oversee healthcare facilities inspection/regulation in all 50 U.S. state HDs, clustered by HD and randomized into two study groups. In November-December 2019, we sent biweekly e-mails containing links to a website summarizing evidence on abortion facility regulation. E-mails/headers sent to one group emphasized public health values and did not include the word abortion; e-mails/headers to the other group used the word abortion. Primary outcome measures were e-mail open rates and click-through rates. Among 221 participants to whom e-mails were deliverable, the overall open rate was 36%. Open rate was 25% for PH values and 46% for abortion groups (p < .05). Effects were moderated by state abortion policy environment: in both supportive and restrictive environments, participants in the abortion messaging group were statistically more likely to open e-mails than those in the PH values group. There was no difference between groups in states with middle-ground abortion policy environments. Among participants opening at least one e-mail, 19% clicked through to the website, with no significant difference by group. This study demonstrates that repeated targeted e-mail campaigns can reach HD professionals with research summaries. Concerns that communications to HDs should avoid the word abortion are unsupported.
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Affiliation(s)
- Katie Woodruff
- Department of Obstetrics, Gynecology and Reproductive Sciences; University of California, San Francisco
| | - Nancy Berglas
- Department of Obstetrics, Gynecology and Reproductive Sciences; University of California, San Francisco
| | - Stephanie Herold
- Department of Obstetrics, Gynecology and Reproductive Sciences; University of California, San Francisco
| | - Sarah C M Roberts
- Department of Obstetrics, Gynecology and Reproductive Sciences; University of California, San Francisco
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Gerdts C, Fuentes L, Grossman D, White K, Keefe-Oates B, Baum SE, Hopkins K, Stolp CW, Potter JE. Impact of Clinic Closures on Women Obtaining Abortion Services After Implementation of a Restrictive Law in Texas. Am J Public Health 2022; 112:1297-1304. [PMID: 35969823 PMCID: PMC9382170 DOI: 10.2105/ajph.2016.303134r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ohio Abortion Regulations and Ethical Dilemmas for Obstetrician–Gynecologists. Obstet Gynecol 2022; 140:253-261. [DOI: 10.1097/aog.0000000000004870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 05/12/2022] [Indexed: 11/25/2022]
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Seymour JW, Thompson TA, Milechin D, Wise LA, Rudolph AE. Potential Impact of Telemedicine for Medication Abortion Policy and Programming Changes on Abortion Accessibility in the United States. Am J Public Health 2022; 112:1202-1211. [PMID: 35830676 PMCID: PMC9342822 DOI: 10.2105/ajph.2022.306876] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2022] [Indexed: 11/04/2022]
Abstract
Objectives. To quantify the impact of telemedicine for medication abortion (TMAB) expansion or ban removal on abortion accessibility. Methods. We included 1091 facilities from the 2018 Advancing New Standards in Reproductive Health facility database and Planned Parenthood Web site, among which 241 did not offer abortion as sites for TMAB expansion. Accessibility was defined as the proportion of reproductive-aged women living within a 30-, 60-, or 90-minute drive time from an abortion-providing facility. We calculated accessibility differences between 3 scenarios: (1) facilities offering abortion in 2018 (reference), (2) the reference scenario in addition to all facilities in states without TMAB bans (TMAB expansion), and (3) all facilities (TMAB ban removal). We also stratified by state and urban-rural status. Results. In 2018, 65%, 81%, and 89% of women lived within a 30-, 60-, or 90-minute drive time from an abortion-providing facility, respectively. Expansion and ban removal expanded abortion accessibility relative to the current accessibility scenario (range: 1.25-5.66 percentage points). Women in rural blocks experienced greater increases in accessibility than those in urban blocks. Conclusions. TMAB program and policy changes could expand abortion accessibility to an additional 3.5 million reproductive-aged women. Public Health Implications. Our findings can inform where to invest resources to improve abortion accessibility. (Am J Public Health. 2022;112(8):1202-1211. https://doi.org/10.2105/AJPH.2022.306876).
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Affiliation(s)
- Jane W Seymour
- Jane W. Seymour is with the Department of Epidemiology, School of Public Health, Boston University, Boston, MA, and Ibis Reproductive Health, Cambridge, MA. Terri-Ann Thompson is with Ibis Reproductive Health. Dennis Milechin is with Research Computing Services, Information Services and Technology, Boston University. Lauren A. Wise is with the Department of Epidemiology, School of Public Health, Boston University. Abby E. Rudolph is with the Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, PA
| | - Terri-Ann Thompson
- Jane W. Seymour is with the Department of Epidemiology, School of Public Health, Boston University, Boston, MA, and Ibis Reproductive Health, Cambridge, MA. Terri-Ann Thompson is with Ibis Reproductive Health. Dennis Milechin is with Research Computing Services, Information Services and Technology, Boston University. Lauren A. Wise is with the Department of Epidemiology, School of Public Health, Boston University. Abby E. Rudolph is with the Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, PA
| | - Dennis Milechin
- Jane W. Seymour is with the Department of Epidemiology, School of Public Health, Boston University, Boston, MA, and Ibis Reproductive Health, Cambridge, MA. Terri-Ann Thompson is with Ibis Reproductive Health. Dennis Milechin is with Research Computing Services, Information Services and Technology, Boston University. Lauren A. Wise is with the Department of Epidemiology, School of Public Health, Boston University. Abby E. Rudolph is with the Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, PA
| | - Lauren A Wise
- Jane W. Seymour is with the Department of Epidemiology, School of Public Health, Boston University, Boston, MA, and Ibis Reproductive Health, Cambridge, MA. Terri-Ann Thompson is with Ibis Reproductive Health. Dennis Milechin is with Research Computing Services, Information Services and Technology, Boston University. Lauren A. Wise is with the Department of Epidemiology, School of Public Health, Boston University. Abby E. Rudolph is with the Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, PA
| | - Abby E Rudolph
- Jane W. Seymour is with the Department of Epidemiology, School of Public Health, Boston University, Boston, MA, and Ibis Reproductive Health, Cambridge, MA. Terri-Ann Thompson is with Ibis Reproductive Health. Dennis Milechin is with Research Computing Services, Information Services and Technology, Boston University. Lauren A. Wise is with the Department of Epidemiology, School of Public Health, Boston University. Abby E. Rudolph is with the Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, PA
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Roberts SCM, Berglas NF, Schroeder R, Lingwall M, Grossman D, White K. Disruptions to Abortion Care in Louisiana During Early Months of the COVID-19 Pandemic. Am J Public Health 2021; 111:1504-1512. [PMID: 34185578 PMCID: PMC8489634 DOI: 10.2105/ajph.2021.306284] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To examine changes in abortions in Louisiana before and after the COVID-19 pandemic onset and assess whether variations in abortion service availability during this time might explain observed changes. Methods. We collected monthly service data from abortion clinics in Louisiana and neighboring states among Louisiana residents (January 2018‒May 2020) and assessed changes in abortions following pandemic onset. We conducted mystery client calls to 30 abortion clinics in Louisiana and neighboring states (April‒July 2020) and examined the percentage of open and scheduling clinics and median waits. Results. The number of abortions per month among Louisiana residents in Louisiana clinics decreased 31% (incidence rate ratio = 0.69; 95% confidence interval [CI] = 0.59, 0.79) from before to after pandemic onset, while the odds of having a second-trimester abortion increased (adjusted odds ratio [AOR] = 1.91; 95% CI = 1.10, 3.33). The decrease was not offset by an increase in out-of-state abortions. In Louisiana, only 1 or 2 (of 3) clinics were open (with a median wait > 2 weeks) through early May. Conclusions. The COVID-19 pandemic onset was associated with a significant decrease in the number of abortions and increase in the proportion of abortions provided in the second trimester among Louisiana residents. These changes followed service disruptions.
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Affiliation(s)
- Sarah C M Roberts
- Sarah C. M. Roberts, Nancy F. Berglas, Rosalyn Schroeder, Mary Lingwall, and Daniel Grossman are with Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, Oakland. Kari White is with the Texas Policy Evaluation Project, Population Research Center, University of Texas at Austin
| | - Nancy F Berglas
- Sarah C. M. Roberts, Nancy F. Berglas, Rosalyn Schroeder, Mary Lingwall, and Daniel Grossman are with Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, Oakland. Kari White is with the Texas Policy Evaluation Project, Population Research Center, University of Texas at Austin
| | - Rosalyn Schroeder
- Sarah C. M. Roberts, Nancy F. Berglas, Rosalyn Schroeder, Mary Lingwall, and Daniel Grossman are with Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, Oakland. Kari White is with the Texas Policy Evaluation Project, Population Research Center, University of Texas at Austin
| | - Mary Lingwall
- Sarah C. M. Roberts, Nancy F. Berglas, Rosalyn Schroeder, Mary Lingwall, and Daniel Grossman are with Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, Oakland. Kari White is with the Texas Policy Evaluation Project, Population Research Center, University of Texas at Austin
| | - Daniel Grossman
- Sarah C. M. Roberts, Nancy F. Berglas, Rosalyn Schroeder, Mary Lingwall, and Daniel Grossman are with Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, Oakland. Kari White is with the Texas Policy Evaluation Project, Population Research Center, University of Texas at Austin
| | - Kari White
- Sarah C. M. Roberts, Nancy F. Berglas, Rosalyn Schroeder, Mary Lingwall, and Daniel Grossman are with Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, Oakland. Kari White is with the Texas Policy Evaluation Project, Population Research Center, University of Texas at Austin
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Biggs MA, Neilands TB, Kaller S, Wingo E, Ralph LJ. Developing and validating the Psychosocial Burden among people Seeking Abortion Scale (PB-SAS). PLoS One 2020; 15:e0242463. [PMID: 33301480 PMCID: PMC7728247 DOI: 10.1371/journal.pone.0242463] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 11/03/2020] [Indexed: 11/23/2022] Open
Abstract
While there is a large body of research demonstrating that having an abortion is not associated with adverse mental health outcomes, less research has examined which factors may contribute to elevated levels of mental health symptoms at the time of abortion seeking. This study aims to develop and validate a new tool to measure dimensions of psychosocial burden experienced by people seeking abortion in the United States. To develop scale items, we reviewed the literature including existing measures of stress and anxiety and conducted interviews with experts in abortion care and with patients seeking abortion. Thirty-five items were administered to 784 people seeking abortion at four facilities located in three U.S. states. We used exploratory factor analysis (EFA) to reduce items and identify key domains of psychosocial burden. We assessed the predictive validity of the overall scale and each sub-scale, by assessing their associations with validated measures of perceived stress, anxiety, and depression using multivariable linear regression models. Factor analyses revealed a 12-item factor solution measuring psychosocial burden seeking abortion, with four subdomains: structural challenges, pregnancy decision-making, lack of autonomy, and others' reactions to the pregnancy. The alpha reliability coefficients were acceptable for the overall scale (α = 0.83) and each subscale (ranging from α = 0.82-0.85). In adjusted analyses, the overall scale was significantly associated with stress, anxiety and depression; each subscale was also significantly associated with each mental health outcome. This new scale offers a practical tool for providers and researchers to empirically document the factors associated with people's psychological well-being at the time of seeking an abortion. Findings suggest that the same restrictions that claim to protect people from mental health harm may be increasing people's psychosocial burden and contributing to adverse psychological outcomes at the time of seeking abortion.
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Affiliation(s)
- M. Antonia Biggs
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Torsten B. Neilands
- Division of Prevention Science, Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Shelly Kaller
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Erin Wingo
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Lauren J. Ralph
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America
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"My good friends on the other side of the aisle aren't bothered by those facts": U.S. State legislators' use of evidence in making policy on abortion. Contraception 2019; 101:249-255. [PMID: 31881221 DOI: 10.1016/j.contraception.2019.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 11/15/2019] [Accepted: 11/15/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE In recent years, U.S. states have passed many restrictive abortion policies with a rationale of protecting health and safety, in apparent contravention of abundant scientific evidence on abortion safety. This study explored whether and how state legislators use scientific evidence when deciding abortion policy. STUDY DESIGN We conducted 29 semi-structured interviews with state legislators and their aides in Maryland, North Carolina, and Virginia in March through July 2017. We recruited via e-mail to members of all health-related committees of the General Assembly in each state, plus sponsors and co-sponsors of 2017 abortion bills, with follow-up via phone and in person. We conducted iterative thematic analysis of all interview transcripts. RESULTS We found no cases of lawmakers' decisions on abortion being shifted by evidence. However, some lawmakers used evidence in simplified form to support their claims on abortion. Lawmakers gave credence to evidence they received from trusted sources, and that which supported their pre-existing policy preferences. Personal stories appeared more convincing than evidence, with participants drawing broad conclusions from anecdotes. Democrats and Republicans had different views on bias in evidence. CONCLUSIONS In this sample, evidence did not drive state legislators' policymaking on abortion. However, evidence did help inform high-level understanding of abortion, if such evidence supported legislators' pre-existing policy preferences. This work may help public health practitioners and researchers develop more realistic expectations for how research interacts with policymaking. IMPLICATIONS OF THIS WORK To increase the utility of research, reproductive health researchers and practitioners should 1) work with established intermediaries to convey findings to lawmakers; 2) present stories that illustrate research findings; and 3) consider the evidence needs of the judicial branch, in addition to those of legislators.
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Ehrenreich K, Kaller S, Raifman S, Grossman D. Women's Experiences Using Telemedicine to Attend Abortion Information Visits in Utah: A Qualitative Study. Womens Health Issues 2019; 29:407-413. [DOI: 10.1016/j.whi.2019.04.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 04/05/2019] [Accepted: 04/12/2019] [Indexed: 11/15/2022]
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Myers C, Jones R, Upadhyay U. Predicted changes in abortion access and incidence in a post-Roe world. Contraception 2019; 100:367-373. [PMID: 31376381 DOI: 10.1016/j.contraception.2019.07.139] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 07/16/2019] [Accepted: 07/18/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To examine changes in travel distance and abortion incidence if Roe v. Wade were reversed or if abortion were further restricted. STUDY DESIGN We used a national database of abortion facilities to calculate travel distances from the population centroids of United States counties to the nearest publicly-identifiable abortion facility. We then estimated these travel distances under two hypothetical post-Roe scenarios. In the first, abortion becomes illegal in eight states with preemptive "trigger bans." In the second, abortion becomes illegal in an additional 13 states classified as at high risk of outlawing abortions under most circumstances. Using previously-published estimates of the short-run causal effects of increases in travel distances on abortion rates in Texas, we estimate changes in abortion incidence under each scenario. RESULTS If Roe were reversed and all high-risk states banned abortion, 39% of the national population of women aged 15-44 would experience increases in travel distances ranging from less than 1 mile to 791 miles. If these women respond similarly to travel distances as Texas women, county-level abortion rates would fall by amounts ranging from less than 1% to more than 40%. Aggregating across all affected regions, the average resident is expected to experience a 249 mile increase in travel distance, and the abortion rate is predicted to fall by 32.8% (95% confidence interval 25.9-39.6%) in the year following a Roe reversal. CONCLUSION In the year following a reversal, increases in travel distances are predicted to prevent 93,546-143,561 women from accessing abortion care. IMPLICATIONS A reversal or weakening of Roe is likely to increase spatial disparities in abortion access. This could translate to a reduction in abortion rates and an increase in unwanted births and self-managed abortions.
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Affiliation(s)
- Caitlin Myers
- Middlebury College, Middlebury, VT; Guttmacher Institute, New York, NY; Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland, CA.
| | - Rachel Jones
- Middlebury College, Middlebury, VT; Guttmacher Institute, New York, NY; Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland, CA
| | - Ushma Upadhyay
- Middlebury College, Middlebury, VT; Guttmacher Institute, New York, NY; Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland, CA
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Fuentes L, Jerman J. Distance Traveled to Obtain Clinical Abortion Care in the United States and Reasons for Clinic Choice. J Womens Health (Larchmt) 2019; 28:1623-1631. [PMID: 31282804 PMCID: PMC6919239 DOI: 10.1089/jwh.2018.7496] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Greater distance to abortion facilities is associated with greater out-of-pocket costs, emergency room follow-up care, negative mental health, and delayed care among U.S. abortion patients. However, the distance U.S. abortion patients travel has not been reported since 2008, and no study has examined reasons abortion patients choose the particular facility where they obtain their abortion. Materials and Methods: We analyzed data from the 2014 Abortion Patient Survey and Abortion Provider Census to report abortion patients' one-way travel from their resident zip code to their abortion clinic, whether they went to the closest clinic, and reasons for facility choice. We report unadjusted and adjusted associations of patients' characteristics with travel distance and differences in average travel distance by abortion patients' reported reasons for choosing their facility. Results: In 2014, 65% of abortion patients traveled less than 25 miles one-way, 17% traveled 25–49 miles, and 18% traveled more than 50 miles. Abortion patients who were white, college-educated, U.S.-born, ≥12 weeks pregnant, and lived outside metropolitan areas were more likely to travel farther. Nearly half of abortion patients went to their nearest provider and 32% chose their facility because it was the closest. Conclusion: These results indicate that travel distance is an important determinant of abortion care access in the United States. Nearly, one-fifth of U.S. abortion patients traveled more than 50 miles one-way and the most common reason reported for clinic choice was that it was the closest.
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Affiliation(s)
- Liza Fuentes
- Research Division, Guttmacher Institute, New York, New York
| | - Jenna Jerman
- Research Division, Guttmacher Institute, New York, New York
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Trends in nonresident abortion rates in New York City from 2005 to 2015: a time series analysis. Contraception 2019; 100:182-187. [PMID: 31136730 DOI: 10.1016/j.contraception.2019.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 05/14/2019] [Accepted: 05/14/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To examine trends and utilization patterns of NYC abortion services by nonresidents since growing abortion restrictions across many states could drive women to seek care in less restrictive jurisdictions including NYC. STUDY DESIGN We used data from Induced Termination of Pregnancy certificates filed with the NYC Department of Health and Mental Hygiene in 2005-2015. An autoregressive integrated moving average (ARIMA) model was fit to the monthly nonresident abortion rate time series. Pearson's χ2 tests determined associations between women's residence and other variables. RESULTS During 2005-2015, 885,816 abortions were reported in NYC, with 76,990 (8.7%) among nonresidents; 50,211 (65.2%) nonresidents lived in other New York State counties. The NYC abortion rate declined from 49.4 per 1000 women 15-44 in 2005 to 32.7 in 2015, while the nonresident rate showed minimal change from 0.12 per 1000 US women 15-44 in 2005 to 0.10 in 2015. ARIMA(0,1,1)(0,0,1) [12] fit the time series indicating minimal monthly changes in nonresident rates reflecting seasonal patterns and shorter-term dependencies between successive observations. Nonresidents differed from residents in all investigated variables including terminating at 20+ weeks (9.0% vs. 2.5%, p<.001) and having procedural methods (87.2% vs. 82.2%, p<.001). CONCLUSIONS Nonresidents constituted few abortion patients in NYC with minimal change in nonresident rates in 2005-2015. Nonresidents more often sought later-term abortions and more complicated procedures posing greater associated costs/risks. Monitoring nonresident abortion trends and utilization patterns is valuable for planning local service delivery particularly in jurisdictions committed to providing comprehensive women's healthcare where nonresidents may increasingly seek abortions. IMPLICATIONS While we found limited change in nonresident abortion rates in NYC in 2005-2015, other jurisdictions bordering more restrictive states could show different results and should consider conducting similar research. Such analyses are important in jurisdictions committed to providing comprehensive women's healthcare where nonresidents may increasingly seek abortions in the future.
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Barr-Walker J, Jayaweera RT, Ramirez AM, Gerdts C. Experiences of women who travel for abortion: A mixed methods systematic review. PLoS One 2019; 14:e0209991. [PMID: 30964860 PMCID: PMC6456165 DOI: 10.1371/journal.pone.0209991] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 12/16/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To systematically review the literature on women's experiences traveling for abortion and assess how this concept has been explored and operationalized, with a focus on travel distance, cost, delays, and other barriers to receiving services. BACKGROUND Increasing limitations on abortion providers and access to care have increased the necessity of travel for abortion services around the world. No systematic examination of women's experiences traveling for abortion has been conducted; this mixed-methods review provides a summary of the qualitative and quantitative literature on this topic. METHODS A systematic search was conducted using PubMed, Embase, Web of Science, Popline, and Google Scholar in July 2016 and updated in March 2017 (PROSPERO registration # CRD42016046007). We included original research studies that described women's experiences traveling for abortion. Two reviewers independently performed article screening, data extraction and determination of final inclusion for analysis. Critical appraisal was conducted using CASP, STROBE, and MMAT checklists. RESULTS We included 59 publications: 46 quantitative studies, 12 qualitative studies, and 1 mixed-methods study. Most studies were published in the last five years, relied on data from the US, and discussed travel as a secondary outcome of interest. In quantitative studies, travel was primarily conceptualized and measured as road or straight-line distance to abortion provider, though some studies also incorporated measures of burdens related to travel, such as financial cost, childcare needs, and unwanted disclosure of their abortion status to others. Qualitative studies explored regional disparities in access to abortion care, with a focus on the burdens related to travel, the impact of travel on abortion method choice, and women's reasons for travel. Studies generally were of high quality, though many studies lacked information on participant recruitment or consideration of potential biases. CONCLUSIONS Standardized measurements of travel, including burdens associated with travel and more nuanced considerations of travel costs, should be implemented in order to facilitate comparison across studies. More research is needed to explore and accurately capture different dimensions of the burden of travel for abortion services on women's lives.
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Affiliation(s)
- Jill Barr-Walker
- ZSFG Library, University of California, San Francisco, San Francisco, California, United States of America
- * E-mail:
| | - Ruvani T. Jayaweera
- Ibis Reproductive Health, Oakland, California, United States of America
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California, United States of America
| | - Ana Maria Ramirez
- Ibis Reproductive Health, Oakland, California, United States of America
| | - Caitlin Gerdts
- Ibis Reproductive Health, Oakland, California, United States of America
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Ely G, Polmanteer RSR, Caron A. Access to Abortion Services in Tennessee: Does Distance Traveled and Geographic Location Influence Return for a Second Appointment as Required by the Mandatory Waiting Period Policy? HEALTH & SOCIAL WORK 2019; 44:13-21. [PMID: 30561624 DOI: 10.1093/hsw/hly039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 08/16/2018] [Indexed: 06/09/2023]
Abstract
The purpose of this article was to examine the average distance traveled to access an abortion procedure, rates of return for the procedure, and whether or not those living in rural zip codes were less likely to return for the abortion compared with residents in urban zip codes, in the context of a 48-hour in-person mandatory waiting period in Tennessee. Findings indicated that over 12 percent of patients who attended the in-person counseling session did not return for the procedure. Moreover, abortion patients in this study traveled an average of 50.53 miles to access abortion care, which is notably higher than the estimated national average of 11.00 miles. Rural residents were significantly more likely than urban residents to have to travel farther to access abortion services. However, neither geographic location nor distance traveled were predictive of returning to the clinic for the second appointment to obtain the abortion, suggesting that patients who did return were able to overcome any geographic disparities. Given the policy mandate that requires a minimum of two in-person clinic visits to obtain the abortion, patients who are traveling farther must still use more resources for two trips, which is a burden to them that is not experienced by more urban residents who are located in closer proximity to abortion providers. The article concludes with a discussion of the implications of the findings for social work practice and policy.
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Affiliation(s)
- Gretchen Ely
- Gretchen Ely, PhD, is associate professor, School of Social Work, University at Buffalo, State University of New York. Rebecca S. Rouland Polmanteer, PhD, LMSW, is assistant professor, Department of Social Work, Nazareth College, Rochester, NY. Amelia Caron is a doula, Knoxville Abortion Doula Collective, Planned Parenthood of Middle/East Tennessee, Knoxville
| | - Rebecca S Rouland Polmanteer
- Gretchen Ely, PhD, is associate professor, School of Social Work, University at Buffalo, State University of New York. Rebecca S. Rouland Polmanteer, PhD, LMSW, is assistant professor, Department of Social Work, Nazareth College, Rochester, NY. Amelia Caron is a doula, Knoxville Abortion Doula Collective, Planned Parenthood of Middle/East Tennessee, Knoxville
| | - Amelia Caron
- Gretchen Ely, PhD, is associate professor, School of Social Work, University at Buffalo, State University of New York. Rebecca S. Rouland Polmanteer, PhD, LMSW, is assistant professor, Department of Social Work, Nazareth College, Rochester, NY. Amelia Caron is a doula, Knoxville Abortion Doula Collective, Planned Parenthood of Middle/East Tennessee, Knoxville
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O'Donnell J, Goldberg A, Betancourt T, Lieberman E. Access to Abortion in Central Appalachian States: Examining County of Residence and County-Level Attributes. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2018; 50:165-172. [PMID: 30238682 DOI: 10.1363/psrh.12079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 05/22/2018] [Accepted: 05/24/2018] [Indexed: 06/08/2023]
Abstract
CONTEXT Studies of how women's individual characteristics and place of residence are related to variability in gestational age at the time of abortion have not examined county of residence and county-level characteristics. The county level is potentially meaningful, given that county is the smallest geographic unit with policy implications. METHODS Data on 38,611 abortions that took place in North Carolina, Virginia and West Virginia in 2012 were used to study the relationship between gestational age and county-level attributes (e.g., metropolitan status and poverty). Three-level hierarchical linear models captured individuals nested in county of residence, clustered by state of residence, and adjusted for individual characteristics and distance traveled to care. RESULTS Eight percent of the variation in gestational age at abortion was attributable to county-level characteristics. Residents of counties characterized by persistent poverty obtained abortions 2.3 days later in gestation than those from counties not characterized by that level of economic hardship. Women living in nonmetropolitan counties obtained abortions 1.7 days later than those living in metropolitan counties, even after distance traveled and county-level poverty were controlled for. CONCLUSION County of residence is relevant to gestational age at the time of abortion for women in these three states. Evidence that county-level attributes are related to access adds insight to the consequences for women when the landscape of abortion service delivery shifts. Integrating county of residence into research on access to abortion services may be critical to capturing disparities in access.
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Affiliation(s)
| | - Alisa Goldberg
- Associate professor, Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston
| | - Theresa Betancourt
- Salem Professor in Global Practice and director, Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, MA
| | - Ellice Lieberman
- Professor, Department of Social and Behavioral Sciences and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston
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Upadhyay UD, Cartwright AF, Goyal V, Belusa E, Roberts SCM. Admitting privileges and hospital-based care after presenting for abortion: A retrospective case series. Health Serv Res 2018; 54:425-436. [PMID: 30423207 PMCID: PMC6407355 DOI: 10.1111/1475-6773.13080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective To examine the pathways of care for abortion patients transferred or referred to emergency departments (EDs) or hospitals before and after abortion‐providing physicians obtained hospital admitting privileges. Data Sources This case series was based on retrospective chart review at three abortion clinics in which physicians had obtained admitting privileges in the previous 5 years. Study Design We identified patients who were transferred or referred to a hospital or ED. Patients were grouped according to the pathway by which their care was transferred or referred to the ED/hospital. Principal Findings Both before and after admitting privileges, the majority of patients were referred to a hospital before the abortion was attempted and most were for suspected ectopic pregnancy or to perform the abortion in a hospital. Direct ambulance transfer from the facility to the ED/hospital was the least common pathway. We observed few changes in practice from before to after admitting privileges. Preexisting mechanisms of coordination and communication facilitated care that was tailored for the specific patient. Conclusions We did not find evidence that physician admitting privileges influenced the pathways through which abortion patients obtain hospital‐based care, as existing mechanisms of collaboration between hospitals and abortion facilities allowed for management of patients who sought hospital‐based care.
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Affiliation(s)
- Ushma D Upadhyay
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland, California
| | - Alice F Cartwright
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland, California
| | - Vinita Goyal
- Population Research Center, University of Texas at Austin, Austin, Texas
| | - Elise Belusa
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland, California
| | - Sarah C M Roberts
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland, California
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Cartwright AF, Karunaratne M, Barr-Walker J, Johns NE, Upadhyay UD. Identifying National Availability of Abortion Care and Distance From Major US Cities: Systematic Online Search. J Med Internet Res 2018; 20:e186. [PMID: 29759954 PMCID: PMC5972217 DOI: 10.2196/jmir.9717] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 03/08/2018] [Accepted: 04/02/2018] [Indexed: 01/19/2023] Open
Abstract
Background Abortion is a common medical procedure, yet its availability has become more limited across the United States over the past decade. Women who do not know where to go for abortion care may use the internet to find abortion facility information, and there appears to be more online searches for abortion in states with more restrictive abortion laws. While previous studies have examined the distances women must travel to reach an abortion provider, to our knowledge no studies have used a systematic online search to document the geographic locations and services of abortion facilities. Objective The objective of our study was to describe abortion facilities and services available in the United States from the perspective of a potential patient searching online and to identify US cities where people must travel the farthest to obtain abortion care. Methods In early 2017, we conducted a systematic online search for abortion facilities in every state and the largest cities in each state. We recorded facility locations, types of abortion services available, and facility gestational limits. We then summarized the frequencies by region and state. If the online information was incomplete or unclear, we called the facility using a mystery shopper method, which simulates the perspective of patients calling for services. We also calculated distance to the closest abortion facility from all US cities with populations of 50,000 or more. Results We identified 780 facilities through our online search, with the fewest in the Midwest and South. Over 30% (236/780, 30.3%) of all facilities advertised the provision of medication abortion services only; this proportion was close to 40% in the Northeast (89/233, 38.2%) and West (104/262, 39.7%). The lowest gestational limit at which services were provided was 12 weeks in Wyoming; the highest was 28 weeks in New Mexico. People in 27 US cities must travel over 100 miles (160 km) to reach an abortion facility; the state with the largest number of such cities is Texas (n=10). Conclusions Online searches can provide detailed information about the location of abortion facilities and the types of services they provide. However, these facilities are not evenly distributed geographically, and many large US cities do not have an abortion facility. Long distances can push women to seek abortion in later gestations when care is even more limited.
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Affiliation(s)
- Alice F Cartwright
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, Oakland, CA, United States
| | | | - Jill Barr-Walker
- Zuckerberg San Francisco General Library, University of California, San Francisco, San Francisco, CA, United States
| | - Nicole E Johns
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, Oakland, CA, United States
| | - Ushma D Upadhyay
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, Oakland, CA, United States
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Austin N, Harper S. Assessing the impact of TRAP laws on abortion and women's health in the USA: a systematic review. BMJ SEXUAL & REPRODUCTIVE HEALTH 2018; 44:128-134. [PMID: 29921636 DOI: 10.1136/bmjsrh-2017-101866] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 01/26/2018] [Accepted: 02/06/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Targeted Regulation of Abortion Providers (TRAP) laws impose extensive and sometimes costly requirements on abortion providers and facilities, potentially leading to barriers to care. Understanding the impact of these laws is important given their prevalence in the USA, but no review to date has summarised the available evidence. We conducted a systematic review of literature on TRAP laws and their impact on abortion trends and women's health. METHODS We searched MEDLINE, PubMed and EconLit for original, quantitative studies where the exposure was at least one TRAP policy and the outcome was abortion and/or any women's physical or mental health outcome. RESULTS Six articles met our inclusion criteria. The most common outcome was population-level abortion trends; studies also assessed the effect of TRAP laws on gestational age at presentation and measures of self-perceived burden. While certain TRAP laws (eg, admitting privilege requirements) appeared to have an effect on abortion outcomes, the impact of other laws - or combinations of laws - was unclear, due in part to heterogeneity between studies with respect to study design, geography, and exposure definition. CONCLUSIONS TRAP laws may have an impact on the experience of obtaining an abortion in the USA. However, our review revealed a paucity of empirical research on their population and individual-level impact, as well as some disagreement about the effect of different TRAP laws on subsequent abortion outcomes. Future research should prioritise the specific TRAP laws that may have a uniquely strong effect on state-level abortion rates and other outcomes.
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Affiliation(s)
- Nichole Austin
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
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Grindlay K, Seymour JW, Fix L, Reiger S, Keefe-Oates B, Grossman D. Abortion Knowledge and Experiences Among U.S. Servicewomen: A Qualitative Study. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2017; 49:245-252. [PMID: 29140582 DOI: 10.1363/psrh.12044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 09/16/2017] [Accepted: 09/18/2017] [Indexed: 06/07/2023]
Abstract
CONTEXT U.S. servicewomen have a higher rate of unintended pregnancy than civilian women, yet the military does not provide or cover abortion, except in limited circumstances. Servicewomen's experiences with abortion care have received little research attention. METHODS Twenty-one in-depth interviews with servicewomen who had had an abortion during active-duty service in the prior two years were conducted between January 2015 and July 2016. Women reported on their experiences accessing abortion, as well as their knowledge and opinions of the military's abortion policy. Data were analyzed thematically using inductive and deductive codes. RESULTS In regard to their pregnancy and abortion experiences, servicewomen cited concerns about confidentiality, stigma and negative effects on their career, which prevented half of participants from seeking care from the military. Of those who visited a military treatment facility during pregnancy, some reported feeling upset or abandoned by the lack of options counseling and referral. Women reported that the military's abortion policy had negative health and emotional consequences for servicewomen, and negative financial and logistical consequences for both servicewomen and the military. Most did not have accurate knowledge of the abortion policy. Upon learning the law, the majority believed that the military should provide and cover abortion; yet, servicewomen also expressed apprehension about the military's involvement in abortion care, because of concerns about privacy and negative effects on women's careers. CONCLUSIONS Policy recommendations to better meet the needs of servicewomen include wider dissemination of the military's abortion policy, establishing abortion referral and support guidelines, and improving confidentiality in military health services.
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Affiliation(s)
| | - Jane W Seymour
- Project manager, Ibis Reproductive Health, Cambridge, MA
| | - Laura Fix
- Project manager, Ibis Reproductive Health, Cambridge, MA
| | - Sarah Reiger
- Project manager, Ibis Reproductive Health, Cambridge, MA
| | | | - Daniel Grossman
- Director of Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, University of California, San Francisco, Oakland, CA
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Jerman J, Frohwirth L, Kavanaugh ML, Blades N. Barriers to Abortion Care and Their Consequences For Patients Traveling for Services: Qualitative Findings from Two States. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2017; 49:95-102. [PMID: 28394463 PMCID: PMC5953191 DOI: 10.1363/psrh.12024] [Citation(s) in RCA: 123] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 01/12/2017] [Accepted: 01/19/2017] [Indexed: 05/22/2023]
Abstract
CONTEXT Abortion availability and accessibility vary by state. Especially in areas where services are restricted or limited, some women travel to obtain abortion services in other states. Little is known about the experience of travel to obtain abortion. METHODS In January and February 2015, in-depth interviews were conducted with 29 patients seeking abortion services at six facilities in Michigan and New Mexico. Eligible women were 18 or older, spoke English, and had traveled either across state lines or more than 100 miles within the state. Respondents were asked to describe their experience from pregnancy discovery to the day of the abortion procedure. Barriers to accessing abortion care and consequences of these barriers were identified through inductive and deductive analysis. RESULTS Respondents described 15 barriers to abortion care while traveling to obtain services, and three major consequences of experiencing those barriers. Barriers were grouped into five categories: travel-related logistical issues, system navigation issues, limited clinic options, financial issues, and state or clinic restrictions. Consequences were delays in care, negative mental health impacts and considering self-induction. The experience of barriers complicated the process of obtaining an abortion, but the effect of any individual barrier was unclear. Instead, the experience of multiple barriers appeared to have a compounding effect, resulting in negative consequences for women traveling for abortion. CONCLUSION The amalgamation of barriers to abortion care experienced simultaneously can have significant consequences for patients.
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Affiliation(s)
- Jenna Jerman
- research, associate, Guttmacher Institute, New York
| | - Lori Frohwirth
- senior research, associate Guttmacher Institute, New York
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Johns NE, Foster DG, Upadhyay UD. Distance traveled for Medicaid-covered abortion care in California. BMC Health Serv Res 2017; 17:287. [PMID: 28420438 PMCID: PMC5395766 DOI: 10.1186/s12913-017-2241-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 04/10/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Access to abortion care in the United States is limited by the availability of abortion providers and their geographic distribution. We aimed to assess how far women travel for Medicaid-funded abortion in California and identify disparities in access to abortion care. METHODS We obtained data on all abortions reimbursed by the fee-for-service California state Medicaid program (Medi-Cal) in 2011 and 2012 and examined distance traveled to obtain abortion care by several demographic and abortion-related factors. Mixed-effects multivariable logistic regression models were constructed to examine factors associated with traveling 50 miles or more. County-level t-tests and linear regressions were conducted to examine the effects of a Medi-Cal abortion provider in a county on overall and urban/rural differences in utilization. RESULTS 11.9% (95% CI: 11.5-12.2%) of women traveled 50 miles or more. Women obtaining second trimester or later abortions (21.7%), women obtaining abortions at hospitals (19.9%), and rural women (51.0%) were most likely to travel 50 miles or more. Across the state, 28 counties, home to 10% of eligible women, did not have a facility routinely providing Medi-Cal-covered abortions. CONCLUSIONS Efforts are needed to expand the number of abortion providers that accept Medi-Cal. This could be accomplished by increasing Medi-Cal reimbursement rates, increasing the types of providers who can provide abortions, and expanding the use of telemedicine. If national trends in declining unintended pregnancy and abortion rates continue, careful attention should be paid to ensure that reduced demand does not lead to greater disparities in geographic and financial access to abortion care by ensuring that providers accepting Medicaid payment are available and widely distributed.
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Affiliation(s)
- Nicole E Johns
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA, 94612, USA.
| | - Diana Greene Foster
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA, 94612, USA
| | - Ushma D Upadhyay
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA, 94612, USA
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Abstract
Despite an increasing number of restrictions on accessing abortion care in the United States, most Americans remain unaware of challenges to obtaining abortion. Theorists of abortion stigma have posited that entertainment media contribute to ongoing lack of knowledge about abortion care. Analyzing all plotlines that aired on American television between 2005 and 2015 in which abortion is considered (n = 89), we examine how access to abortion is portrayed, whether characters are able to surmount barriers, and what documented real-life challenges to access are missing from onscreen representations. We find that 42% show at least one barrier to accessing abortion care, most frequently illegality, cost of the procedure, and social stigma. Almost no barriers—including illegality—are insurmountable, and most are easily overcome for the characters seeking abortion. Some barriers, however, change how abortion is understood by a character such that she opts to continue the pregnancy. This underrepresentation of the difficulty of obtaining abortion care may contribute to public beliefs that abortion restrictions do not pose real challenges for women’s access to abortion.
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Sisson G, Ralph L, Gould H, Foster DG. Adoption Decision Making among Women Seeking Abortion. Womens Health Issues 2017; 27:136-144. [PMID: 28153742 DOI: 10.1016/j.whi.2016.11.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 10/25/2016] [Accepted: 11/29/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Little is known about how adoption factors into pregnancy decision making, particularly when abortion is unavailable. METHODS We used data from the Turnaway Study, a longitudinal study of 956 women seeking abortion, including 231 women denied abortions owing to gestational limits. Through semiannual quantitative interviews, we assessed the frequency with which women denied abortion consider and choose adoption, and, among adoption participants, decision satisfaction. We compared differences in the demographic profiles of parenting and adoption participants using mixed effects regression models. We conducted in-depth interviews with 31 women who received or were denied wanted abortions, including 2 adoption participants, focused on understanding pregnancy decision making and feelings about their choice. Interviews were coded using inductive and deductive methods. RESULTS Most women who received abortions were aware of but uninterested in adoption. A minority of women denied abortions (n = 231; 14%) were considering adoption at 1 week after denial. Of participants who gave birth (n = 161), most (91%) chose parenting. Parenting participants (n = 146) did not differ from adoption participants (n = 15) on measures of age, race, or poverty status, although adoption participants were somewhat less likely to be employed (20% vs. 43%; p = .1), and somewhat more likely to have completed high school (87% vs. 74%; p = .08). Although satisfaction with their decision was high among adoption participants, in-depth interviews revealed mixed emotions. CONCLUSIONS Among women motivated to avoid parenthood, as evidenced by abortion seeking, adoption is considered or chosen infrequently. Political promotion of adoption as an alternative to abortion is likely not grounded in the reality of women's decision making.
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Affiliation(s)
- Gretchen Sisson
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, San Francisco, California.
| | - Lauren Ralph
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, San Francisco, California
| | - Heather Gould
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, San Francisco, California
| | - Diana Greene Foster
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, San Francisco, California
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Kimport K. Divergent Successes: What the Abortion Rights Movement Can Learn from Marriage Equality's Success. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2016; 48:221-227. [PMID: 27495972 DOI: 10.1363/48e10416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 05/28/2016] [Accepted: 06/02/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Katrina Kimport
- Assistant professor, Advancing New Standards in Reproductive Health, University of California, San Francisco
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White K, deMartelly V, Grossman D, Turan JM. Experiences Accessing Abortion Care in Alabama among Women Traveling for Services. Womens Health Issues 2016; 26:298-304. [DOI: 10.1016/j.whi.2016.01.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 12/21/2015] [Accepted: 01/08/2016] [Indexed: 11/29/2022]
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Gerdts C, Fuentes L, Grossman D, White K, Keefe-Oates B, Baum SE, Hopkins K, Stolp CW, Potter JE. Impact of Clinic Closures on Women Obtaining Abortion Services After Implementation of a Restrictive Law in Texas. Am J Public Health 2016; 106:857-64. [PMID: 26985603 DOI: 10.2105/ajph.2016.303134] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate the additional burdens experienced by Texas abortion patients whose nearest in-state clinic was one of more than half of facilities providing abortion that had closed after the introduction of House Bill 2 in 2013. METHODS In mid-2014, we surveyed Texas-resident women seeking abortions in 10 Texas facilities (n = 398), including both Planned Parenthood-affiliated clinics and independent providers that performed more than 1500 abortions in 2013 and provided procedures up to a gestational age of at least 14 weeks from last menstrual period. We compared indicators of burden for women whose nearest clinic in 2013 closed and those whose nearest clinic remained open. RESULTS For women whose nearest clinic closed (38%), the mean one-way distance traveled was 85 miles, compared with 22 miles for women whose nearest clinic remained open (P ≤ .001). After adjustment, more women whose nearest clinic closed traveled more than 50 miles (44% vs 10%), had out-of-pocket expenses greater than $100 (32% vs 20%), had a frustrated demand for medication abortion (37% vs 22%), and reported that it was somewhat or very hard to get to the clinic (36% vs 18%; P < .05). CONCLUSIONS Clinic closures after House Bill 2 resulted in significant burdens for women able to obtain care.
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Affiliation(s)
- Caitlin Gerdts
- Caitlin Gerdts, Liza Fuentes, Sarah E. Baum, and Brianna Keefe-Oates are with Ibis Reproductive Health, Oakland, CA. Daniel Grossman is with the University of California, San Francisco. Kari White is with the University of Alabama, Birmingham. Kristine Hopkins, Chandler W. Stolp, and Joseph E. Potter are with the University of Texas at Austin
| | - Liza Fuentes
- Caitlin Gerdts, Liza Fuentes, Sarah E. Baum, and Brianna Keefe-Oates are with Ibis Reproductive Health, Oakland, CA. Daniel Grossman is with the University of California, San Francisco. Kari White is with the University of Alabama, Birmingham. Kristine Hopkins, Chandler W. Stolp, and Joseph E. Potter are with the University of Texas at Austin
| | - Daniel Grossman
- Caitlin Gerdts, Liza Fuentes, Sarah E. Baum, and Brianna Keefe-Oates are with Ibis Reproductive Health, Oakland, CA. Daniel Grossman is with the University of California, San Francisco. Kari White is with the University of Alabama, Birmingham. Kristine Hopkins, Chandler W. Stolp, and Joseph E. Potter are with the University of Texas at Austin
| | - Kari White
- Caitlin Gerdts, Liza Fuentes, Sarah E. Baum, and Brianna Keefe-Oates are with Ibis Reproductive Health, Oakland, CA. Daniel Grossman is with the University of California, San Francisco. Kari White is with the University of Alabama, Birmingham. Kristine Hopkins, Chandler W. Stolp, and Joseph E. Potter are with the University of Texas at Austin
| | - Brianna Keefe-Oates
- Caitlin Gerdts, Liza Fuentes, Sarah E. Baum, and Brianna Keefe-Oates are with Ibis Reproductive Health, Oakland, CA. Daniel Grossman is with the University of California, San Francisco. Kari White is with the University of Alabama, Birmingham. Kristine Hopkins, Chandler W. Stolp, and Joseph E. Potter are with the University of Texas at Austin
| | - Sarah E Baum
- Caitlin Gerdts, Liza Fuentes, Sarah E. Baum, and Brianna Keefe-Oates are with Ibis Reproductive Health, Oakland, CA. Daniel Grossman is with the University of California, San Francisco. Kari White is with the University of Alabama, Birmingham. Kristine Hopkins, Chandler W. Stolp, and Joseph E. Potter are with the University of Texas at Austin
| | - Kristine Hopkins
- Caitlin Gerdts, Liza Fuentes, Sarah E. Baum, and Brianna Keefe-Oates are with Ibis Reproductive Health, Oakland, CA. Daniel Grossman is with the University of California, San Francisco. Kari White is with the University of Alabama, Birmingham. Kristine Hopkins, Chandler W. Stolp, and Joseph E. Potter are with the University of Texas at Austin
| | - Chandler W Stolp
- Caitlin Gerdts, Liza Fuentes, Sarah E. Baum, and Brianna Keefe-Oates are with Ibis Reproductive Health, Oakland, CA. Daniel Grossman is with the University of California, San Francisco. Kari White is with the University of Alabama, Birmingham. Kristine Hopkins, Chandler W. Stolp, and Joseph E. Potter are with the University of Texas at Austin
| | - Joseph E Potter
- Caitlin Gerdts, Liza Fuentes, Sarah E. Baum, and Brianna Keefe-Oates are with Ibis Reproductive Health, Oakland, CA. Daniel Grossman is with the University of California, San Francisco. Kari White is with the University of Alabama, Birmingham. Kristine Hopkins, Chandler W. Stolp, and Joseph E. Potter are with the University of Texas at Austin
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