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Lilly AG, Newman IP, Bjork-James S. Our hands are tied: abortion bans and hesitant medicine. Soc Sci Med 2024; 350:116912. [PMID: 38723584 DOI: 10.1016/j.socscimed.2024.116912] [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: 11/21/2023] [Revised: 04/10/2024] [Accepted: 04/22/2024] [Indexed: 05/21/2024]
Abstract
Trained for decades to analyze risks, benefits, unique body compositions, and complex medical scenarios, healthcare providers are now faced with one of medicine's most trying obstacles: how to practice medicine when new abortion bans contradict best practice standards. Drawn from qualitative interviews with medical providers in Tennessee, USA conducted between October 2022 and December 2022, this study shows how medical providers often must make medical decisions based on legal risks as opposed to standards of care. This is particularly significant as malpractice insurance does not cover criminal charges. In states with abortion bans, often hastily implemented and subject to changes by lawmakers, medical providers are now practicing a new kind of defensive medicine in an effort to protect themselves from legal threats. We call this hesitant medicine, where providers often experience a tension between their own legal protection and the well-being of their patients, making them hesitant to provide necessary abortion care. This has serious, far-reaching consequences. We focus on three distinct arenas impacted by this new form of defensive medicine, specifically: providers' decision-making around patient care, impacts on patient relationships, and finally, what we call the ultimate defense, leaving states with abortion bans to move to states with fewer legal risks. We conclude with commentary on potential ways to reduce the negative impacts of these trends.
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Affiliation(s)
- Anna-Grace Lilly
- Anthropology Department, Vanderbilt University, Garland Hall, Nashville, TN, 37240, USA.
| | - Isabelle P Newman
- Anthropology Department, Vanderbilt University, Garland Hall, Nashville, TN, 37240, USA.
| | - Sophie Bjork-James
- Anthropology Department, Vanderbilt University, Garland Hall, Nashville, TN, 37240, USA.
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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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Sabbath EL, McKetchnie SM, Arora KS, Buchbinder M. US Obstetrician-Gynecologists' Perceived Impacts of Post-Dobbs v Jackson State Abortion Bans. JAMA Netw Open 2024; 7:e2352109. [PMID: 38231510 PMCID: PMC10794934 DOI: 10.1001/jamanetworkopen.2023.52109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 11/29/2023] [Indexed: 01/18/2024] Open
Abstract
Importance Following the Dobbs v Jackson Women's Health Organization decision in June 2022, 17 US states have functionally banned abortion except in narrow circumstances, and physicians found in violation of these laws face felony charges, loss of their medical license, fines, and prison sentences. Patient impacts are being studied closely, but less research has focused on the consequences for obstetrician-gynecologists (OB-GYNs), for whom medically necessary care provision may now carry serious personal and professional consequences. Objective To characterize perceptions of the impact of abortion restrictions on clinical practice, moral distress, mental health, and turnover intention among US OB-GYNs practicing in states with functional bans on abortion. Design, Setting, and Participants This qualitative study included semistructured, remote interviews with OB-GYNs from 13 US states with abortion bans. Volunteer sample of 54 OB-GYNs practicing in states that had banned abortion as of March 2023. Exposure State abortion bans enacted between June 2022 and March 2023. Main Outcomes and Measures OB-GYNs' perceptions of clinical and personal impacts of abortion bans. Results This study included 54 OB-GYNs (mean [SD] age, 42 [7] years; 44 [81%] female participants; 3 [6%] non-Hispanic Black or African American participants; 45 [83%] White participants) who practiced in general obstetrics and gynecology (39 [72%]), maternal-fetal medicine (7 [13%]), and complex family planning (8 [15%]). Two major domains were identified in which the laws affected OB-GYNs: (1) clinical impacts (eg, delays in care until patients became more sick or legal sign-off on a medical exception to the ban was obtained; restrictions on counseling patients on pregnancy options; inability to provide appropriate care oneself or make referrals for such care); and (2) personal impacts (eg, moral distress; fears and perceived consequences of law violation; intention to leave the state; symptoms of depression and anxiety). Conclusions and relevance In this qualitative study of OB-GYNs practicing under abortion bans, participants reported deep and pervasive impacts of state laws, with implications for workforce sustainability, physician health, and patient outcomes. In the context of public policies that restrict physicians' clinical autonomy, organization-level supports for physicians are essential to maintain workforce sustainability, clinician health and well-being, and availability of timely and accessible health care throughout the US.
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Affiliation(s)
- Erika L. Sabbath
- School of Social Work, Boston College, Chestnut Hill, Massachusetts
- Center for Work, Health, and Wellbeing, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | | | - Kavita S. Arora
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill
| | - Mara Buchbinder
- Center for Bioethics, Department of Social Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill
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Schaaf M, Lavelanet A, Codjia L, Nihlén Å, Rehnstrom Loi U. A narrative review of challenges related to healthcare worker rights, roles and responsibilities in the provision of sexual and reproductive services in health facilities. BMJ Glob Health 2023; 8:e012421. [PMID: 37918835 PMCID: PMC10626880 DOI: 10.1136/bmjgh-2023-012421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 10/07/2023] [Indexed: 11/04/2023] Open
Abstract
INTRODUCTION This paper identifies and summarises tensions and challenges related to healthcare worker rights and responsibilities and describes how they affect healthcare worker roles in the provision of sexual and reproductive health (SRH) care in health facilities. METHOD The review was undertaken in a two-phase process, namely: (1) development of a list of core constructs and concepts relating to healthcare worker rights, roles and responsibilities to guide the review and (2) literature review. RESULT A total of 110 papers addressing a variety of SRH areas and geographical locations met our inclusion criteria. These papers addressed challenges to healthcare worker rights, roles and responsibilities, including conflicting laws, policies and guidelines; pressure to achieve coverage and quality; violations of the rights and professionalism of healthcare workers, undercutting their ability and motivation to fulfil their responsibilities; inadequate stewardship of the private sector; competing paradigms for decision-making-such as religious beliefs-that are inconsistent with professional responsibilities; donor conditionalities and fragmentation; and, the persistence of embedded practical norms that are at odds with healthcare worker rights and responsibilities. The tensions lead to a host of undesirable outcomes, ranging from professional frustration to the provision of a narrower range of services or of poor-quality services. CONCLUSION Social mores relating to gender and sexuality and other contested domains that relate to social norms, provider religious identity and other deeply held beliefs complicate the terrain for SRH in particular. Despite the particularities of SRH, a whole of systems response may be best suited to address embedded challenges.
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Affiliation(s)
- Marta Schaaf
- Department of Sexual and Reproductive Health and Research and UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Antonella Lavelanet
- Department of Sexual and Reproductive Health and Research and UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Laurence Codjia
- Department of Health Workforce, World Health Organization, Geneva, Switzerland
| | - Åsa Nihlén
- Department of Sexual and Reproductive Health and Research and UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Ulrika Rehnstrom Loi
- Department of Sexual and Reproductive Health and Research and UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
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Hartwig SA, Youm A, Contreras A, Mosley EA, McCloud C, Goedken P, Carroll E, Lathrop E, Cwiak C, Hall KS. "The right thing to do would be to provide care… and we can't": Provider experiences with Georgia's 22-week abortion ban. Contraception 2023; 124:110059. [PMID: 37160176 DOI: 10.1016/j.contraception.2023.110059] [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: 06/28/2022] [Revised: 05/01/2023] [Accepted: 05/04/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVES In 2015, the Georgia (US) legislature implemented a gestational limit, or "ban" on abortion at or beyond 22 weeks from the last menstrual period. In this study, we qualitatively examined abortion provider perspectives on the ban's impact on abortion care access and provision. STUDY DESIGN Between May 2018 and September 2019, we conducted in-depth individual interviews with 20 abortion providers (clinicians, staff, and administrators) from four clinics in Georgia. Interviews explored perceptions of and experiences with the ban and its effects on abortion care. Team members coded transcripts to 100% agreement using an iterative, group consensus process, and conducted a thematic analysis. RESULTS Participants reported strict adherence to the ban and also its negative consequences: additional labor plus service-delivery restrictions, legally constructed risks for providers, intrusion into the provider-patient relationship, and impact of limited services felt by patients and, thus, providers. Participants commonly mentioned disparities in the ban's impact and viewed the ban as disproportionately affecting people of color, those experiencing financial insecurity, and those with underlying medical conditions. Nonetheless, participants described a clear, unrelenting commitment to providing quality patient-centered care and dedication to and satisfaction in their work. CONCLUSIONS Georgia's ban operates as legislative interference, adversely affecting the provision of quality, patient-centered abortion care, despite providers' resilience and commitment. These experiences in Georgia have timely and clear implications for the entire country following the Supreme Court's decision to overturn Roe v Wade, thus reducing care access and increasing negative health and social consequences and inequities for patients and communities on a national scale. IMPLICATIONS Our findings from Georgia (US) indicate an urgent need for coordinated efforts to challenge the Dobbs v Jackson Women's Health Organization decision and for proactive policies that protect access to later abortion care. Research that identifies strategies for supporting providers and patients faced with continuing restrictive legal environments is warranted.
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Affiliation(s)
- Sophie A Hartwig
- Center for Reproductive Health Research in the Southeast (RISE), Atlanta, GA, USA; Emory University, Rollins School of Public Health, Atlanta, GA, USA.
| | - Awa Youm
- Center for Reproductive Health Research in the Southeast (RISE), Atlanta, GA, USA; Emory University, Rollins School of Public Health, Atlanta, GA, USA
| | - Alyssa Contreras
- Center for Reproductive Health Research in the Southeast (RISE), Atlanta, GA, USA; Emory University, Rollins School of Public Health, Atlanta, GA, USA
| | - Elizabeth A Mosley
- Center for Reproductive Health Research in the Southeast (RISE), Atlanta, GA, USA; Emory University, Rollins School of Public Health, Atlanta, GA, USA
| | - Candace McCloud
- Center for Reproductive Health Research in the Southeast (RISE), Atlanta, GA, USA; Emory University, Rollins School of Public Health, Atlanta, GA, USA
| | - Peggy Goedken
- Emory University, School of Medicine, Department of Gynecology and Obstetrics, Atlanta, GA, USA
| | - Erin Carroll
- Center for Reproductive Health Research in the Southeast (RISE), Atlanta, GA, USA; University of Alabama at Birmingham, Department of Health Care Organization and Policy, Birmingham, AL, USA
| | - Eva Lathrop
- Center for Reproductive Health Research in the Southeast (RISE), Atlanta, GA, USA; Emory University, Rollins School of Public Health, Atlanta, GA, USA; Emory University, School of Medicine, Department of Gynecology and Obstetrics, Atlanta, GA, USA
| | - Carrie Cwiak
- Center for Reproductive Health Research in the Southeast (RISE), Atlanta, GA, USA; Emory University, Rollins School of Public Health, Atlanta, GA, USA; Emory University, School of Medicine, Department of Gynecology and Obstetrics, Atlanta, GA, USA
| | - Kelli Stidham Hall
- Center for Reproductive Health Research in the Southeast (RISE), Atlanta, GA, USA; Emory University, Rollins School of Public Health, Atlanta, GA, USA; Emory University, School of Medicine, Department of Gynecology and Obstetrics, Atlanta, GA, USA
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Mills L, Watermeyer J. A meta-ethnography on the experience and psychosocial implications of providing abortion care. Soc Sci Med 2023; 328:115964. [PMID: 37229933 DOI: 10.1016/j.socscimed.2023.115964] [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: 06/23/2022] [Revised: 04/17/2023] [Accepted: 05/12/2023] [Indexed: 05/27/2023]
Abstract
RATIONALE Challenges unique to abortion care have negative implications for access to safe abortion and the psychosocial well-being of healthcare providers. A deeper understanding of the experience of providing abortion care can inform responsive interventions toward supporting abortion providers and strengthening health systems. OBJECTIVE A meta-ethnography was conducted to describe the experiences of providing abortion care and offer broad conceptual implications of abortion providers' experiences on their psychosocial coping and well-being. METHODS International grey and published research reported in English between 2000 and 2020 was identified via Web of Science Core Collection, PsycInfo, PubMed, Science Direct and Africa-Wide. Studies conducted in contexts where elective abortion is legally permitted were included. Study samples included nurses, physicians, counsellors, administrative staff and other healthcare providers involved in abortion care. Qualitative studies and qualitative data from mixed designs were included. The Critical Appraisal Skills Programme tool was used for appraisal and data was analysed using a meta-ethnographic approach. FINDINGS The review included 47 articles. Five themes arose from the data including the emotional challenges of providing clinical and psychological care, organisational and structural challenges, experiences characterised by stigma, pro-choice narratives, and coping with challenges. Outcomes ranged from moral and emotional alignment, resistance to abortion stigma, and job satisfaction to moral distress, emotional suppression, internalised stigma, selective participation and discontinuation of abortion care. Outcomes were dependent on the nature of interpersonal relationships, working conditions, the internalization of positive or negative messages about abortion, personal history and individual coping styles. CONCLUSIONS Despite facing significant challenges in their work, the presence of positive outcomes among abortion providers and the moderating role of external and individual-level factors on well-being have encouraging implications for supporting psychosocial wellness among abortion providers.
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Affiliation(s)
- Lisa Mills
- School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa; Wits RHI, University of the Witwatersrand, Johannesburg, South Africa.
| | - Jennifer Watermeyer
- School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa.
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Redd SK, AbiSamra R, Blake SC, Komro KA, Neal R, Rice WS, Hall KS. Medication Abortion "Reversal" Laws: How Unsound Science Paved the Way for Dangerous Abortion Policy. Am J Public Health 2023; 113:202-212. [PMID: 36652652 PMCID: PMC9850634 DOI: 10.2105/ajph.2022.307140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2022] [Indexed: 01/19/2023]
Abstract
Objectives. To longitudinally examine the legal landscape of laws requiring abortion patients be informed about the possibility of medication abortion (MAB) "reversal" (in quotes as it does not refer to an evidence-based medical procedure). Methods. We collected legal data on enacted state MAB-reversal laws across all 50 US states and Washington, DC, (collectively, states) from 2012 through 2021. We descriptively analyzed these laws to identify legal variation over time and geography, and conducted a content analysis to identify qualitative themes and patterns in MAB-reversal laws. Results. As of 2021, 14 states (27%)-mostly in the midwestern and southern United States-have enacted MAB-reversal laws. States largely use explicit language to describe reversal, require patients receive information during preabortion counseling, require physicians or physicians' agents to inform patients, instruct patients to contact a health care provider or visit "abortion pill reversal" resources for more information, and require reversal information be posted on state-managed Web sites. Conclusions. Reversal laws continue a dangerous precedent of using unsound science to justify laws regulating abortion access, intrude upon the patient‒provider relationship, and may negatively affect the emotional and physical health of patients seeking an MAB. (Am J Public Health. 2023;113(2):202-212. https://doi.org/10.2105/AJPH.2022.307140).
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Affiliation(s)
- Sara K Redd
- Sara K. Redd and Sarah C. Blake are with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA. Roula AbiSamra is with the Amplify Georgia Collaborative, Atlanta. Kelli A. Komro and Whitney S. Rice are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health. Rachel Neal is with the Department of Gynecology and Obstetrics, School of Medicine, Emory University. Kelli S. Hall is with the Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY
| | - Roula AbiSamra
- Sara K. Redd and Sarah C. Blake are with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA. Roula AbiSamra is with the Amplify Georgia Collaborative, Atlanta. Kelli A. Komro and Whitney S. Rice are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health. Rachel Neal is with the Department of Gynecology and Obstetrics, School of Medicine, Emory University. Kelli S. Hall is with the Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY
| | - Sarah C Blake
- Sara K. Redd and Sarah C. Blake are with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA. Roula AbiSamra is with the Amplify Georgia Collaborative, Atlanta. Kelli A. Komro and Whitney S. Rice are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health. Rachel Neal is with the Department of Gynecology and Obstetrics, School of Medicine, Emory University. Kelli S. Hall is with the Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY
| | - Kelli A Komro
- Sara K. Redd and Sarah C. Blake are with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA. Roula AbiSamra is with the Amplify Georgia Collaborative, Atlanta. Kelli A. Komro and Whitney S. Rice are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health. Rachel Neal is with the Department of Gynecology and Obstetrics, School of Medicine, Emory University. Kelli S. Hall is with the Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY
| | - Rachel Neal
- Sara K. Redd and Sarah C. Blake are with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA. Roula AbiSamra is with the Amplify Georgia Collaborative, Atlanta. Kelli A. Komro and Whitney S. Rice are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health. Rachel Neal is with the Department of Gynecology and Obstetrics, School of Medicine, Emory University. Kelli S. Hall is with the Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY
| | - Whitney S Rice
- Sara K. Redd and Sarah C. Blake are with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA. Roula AbiSamra is with the Amplify Georgia Collaborative, Atlanta. Kelli A. Komro and Whitney S. Rice are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health. Rachel Neal is with the Department of Gynecology and Obstetrics, School of Medicine, Emory University. Kelli S. Hall is with the Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY
| | - Kelli S Hall
- Sara K. Redd and Sarah C. Blake are with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA. Roula AbiSamra is with the Amplify Georgia Collaborative, Atlanta. Kelli A. Komro and Whitney S. Rice are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health. Rachel Neal is with the Department of Gynecology and Obstetrics, School of Medicine, Emory University. Kelli S. Hall is with the Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY
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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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de Londras F, Cleeve A, Rodriguez MI, Farrell A, Furgalska M, Lavelanet A. The impact of mandatory waiting periods on abortion-related outcomes: a synthesis of legal and health evidence. BMC Public Health 2022; 22:1232. [PMID: 35725439 PMCID: PMC9210763 DOI: 10.1186/s12889-022-13620-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/09/2022] [Indexed: 11/10/2022] Open
Abstract
This review follows an established methodology for integrating human rights to address knowledge gaps related to the health and non-health outcomes of mandatory waiting periods (MWPs) for access to abortion. MWP is a requirement imposed by law, policy, or practice, to wait a specified amount of time between requesting and receiving abortion care. Recognizing that MWPs “demean[] women as competent decision-makers”, the World Health Organization recommends against MWPs. International human rights bodies have similarly encouraged states to repeal and not to introduce MWPs, which they recognize as operating as barriers to accessing sexual and reproductive healthcare. This review of 34 studies published between 2010 and 2021, together with international human rights law, establishes the health and non-health harms of MWPs for people seeking abortion, including delayed abortion, opportunity costs, and disproportionate impact. Impacts on abortion providers include increased workloads and system costs.
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Affiliation(s)
- Fiona de Londras
- Birmingham Law School, University of Birmingham (UK), B15 2TT, Birmingham, UK.
| | - Amanda Cleeve
- Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.,Department of Sexual and Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Maria I Rodriguez
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA
| | - Alana Farrell
- Birmingham Law School, University of Birmingham (UK), B15 2TT, Birmingham, UK
| | | | - Antonella Lavelanet
- Department of Sexual and Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
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Carvajal B, White H, Brooks J, Thomson AM, Cooke A. Experiences of midwives and nurses when implementing abortion policies: A systematic integrative review. Midwifery 2022; 111:103363. [DOI: 10.1016/j.midw.2022.103363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/21/2022] [Accepted: 05/09/2022] [Indexed: 11/15/2022]
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de Londras F, Cleeve A, Rodriguez MI, Farrell A, Furgalska M, Lavelanet AF. The impact of provider restrictions on abortion-related outcomes: a synthesis of legal and health evidence. Reprod Health 2022; 19:95. [PMID: 35436888 PMCID: PMC9014563 DOI: 10.1186/s12978-022-01405-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 04/04/2022] [Indexed: 11/16/2022] Open
Abstract
Many components of abortion care in early pregnancy can safely be provided on an outpatient basis by mid-level providers or by pregnant people themselves. Yet, some states impose non-evidence-based provider restrictions, understood as legal or regulatory restrictions on who may provide or manage all or some aspects of abortion care. These restrictions are inconsistent with the World Health Organization’s support for the optimization of the roles of various health workers, and do not usually reflect evidence-based determinations of who can provide abortion. As a matter of international human rights law, states should ensure that the regulation of abortion is evidence-based and proportionate, and disproportionate impacts must be remedied. Furthermore, states are obliged take steps to ensure women do not have to undergo unsafe abortion, to reduce maternal morbidity and mortality, and to effectively protect women and girls from the physical and mental risks associated with unsafe abortion. States must revise their laws to ensure this. Where laws restrict those with the training and competence to provide from participating in abortion care, they are prima facie arbitrary and disproportionate and thus in need of reform. This review, developed by experts in reproductive health, law, policy, and human rights, examined the impact of provider restrictions on people seeking abortion, and medical professionals. The evidence from this review suggests that provider restrictions have negative implications for access to quality abortion, contributing inter alia to delays and recourse to unsafe abortion. A human rights-based approach to abortion regulation would require the removal of overly restrictive provider restrictions. The review provides evidence that speaks to possible routes for regulatory reform by expanding the health workforce involved in abortion-related care, as well as expanding health workers' roles, both of which could improve timely access to first trimester surgical and medical abortion, reduce costs, save time, and reduce the need for travel. This review identifies evidence of the impacts of provider restrictions on people seeking to access abortion and on abortion providers. It pursues a methodology designed to ensure the full integration of public health and human rights standards developed by the research team and published elsewhere. The evidence from this review points clearly to provider restrictions having negative implications for health outcomes, health systems, and human rights. This is especially important as international guidance provided by the WHO indicates best practice in provision and management of abortion and shows clearly that undue provider restrictions are not justified by reference to the nature and complexity of abortion.
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Ward KM. Dirty Work and Intimacy: Creating an Abortion Worker. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2021; 62:512-525. [PMID: 34018439 DOI: 10.1177/00221465211016440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Abortion work has changed in the decades since Roe v. Wade, and concerns over efficiency and cost reduction have resulted in increased specialization and compartmentalization of duties among health workers. This study examines the current state of surgical abortion at a clinic in southern California. Drawing on 18 months of ethnographic fieldwork at an abortion clinic, I use theories of dirty work and intimate work to examine how abortion work is organized and allocated among staff. I find that work in the clinic is best understood as existing on two intersecting spectrums of intimacy and dirtiness. Whereas existing research on abortion workers has primarily focused on doctors and nurses, this study includes medical assistants and compares experiences across different occupations. I conclude that frequency, intensity, and purpose of intimate work and dirty work coalesce to create distinct types of abortion workers.
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Heuerman AC, Bessett D, Matheny Antommaria AH, Tolusso LK, Smith N, Norris AH, McGowan ML. Experiences of reproductive genetic counselors with abortion regulations in Ohio. J Genet Couns 2021; 31:641-652. [PMID: 34755409 DOI: 10.1002/jgc4.1531] [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: 12/22/2020] [Revised: 09/22/2021] [Accepted: 10/16/2021] [Indexed: 11/06/2022]
Abstract
Since 2010, Ohio legislators have passed more than 15 legislative changes related to abortion and abortion providers, and nine procedural abortion clinics have closed. We investigated reproductive genetic counselors' perceptions, attitudes and self-reported practices regarding Ohio's current and proposed abortion regulations. We conducted five focus groups and two telephone interviews in 2019-2020, with a total of 19 reproductive genetic counselors. Participants discussed difficulties keeping current on abortion legislation and clinics' and hospitals' policies, resulting in anticipatory anxiety and leading to additional work to discuss the laws with patients. Participants articulated that practices of reproductive genetic counseling-and patient advocacy-are impeded by the legislation. Genetic counselors perceive negative impacts on patients' autonomy, particularly reflective of healthcare disparities of marginalized groups, which may contribute to frustration and anger. Ultimately, the mental and emotional burden on genetic counselors created by abortion legislation contributes to compassion fatigue and burnout. Our findings show that Ohio's abortion regulations negatively impact reproductive genetic counselors and their relationships with their patients. Repealing existing abortion regulations and preventing future restrictive legislation may ameliorate the negative effects of regulations on reproductive genetic counselors and their patients. In the event that these laws remain, innovative communication tools and proactive professional society advocacy are potential means to mitigate the negative impact on reproductive genetic counselors.
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Affiliation(s)
- Anne C Heuerman
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Genetic Counseling Graduate Program, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Reproductive Genetics Program, Department of Maternal Fetal Medicine, Beaumont Health, Royal Oak, Michigan, USA
| | - Danielle Bessett
- Department of Sociology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Armand H Matheny Antommaria
- Ethics Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Leandra K Tolusso
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Nicki Smith
- Seton Center, Good Samaritan Hospital, TriHealth Hospital Systems, Cincinnati, Ohio, USA
| | - Alison H Norris
- College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Michelle L McGowan
- Ethics Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Department of Women's, Gender & Sexuality Studies, University of Cincinnati, Cincinnati, Ohio, USA
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Barr-Walker J, DePiñeres T, Ossom-Williamson P, Mengesha B, Berglas NF. Countering Misinformation About Abortion: The Role of Health Sciences Librarians. Am J Public Health 2021; 111:1753-1756. [PMID: 34529495 PMCID: PMC8561200 DOI: 10.2105/ajph.2021.306471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Jill Barr-Walker
- Jill Barr-Walker is with ZSFG Library, University of California, San Francisco, and the Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco. Teresa DePiñeres is with Innovations in Reproductive Health, Miami, FL. Peace Ossom-Williamson is with the UTA Libraries, University of Texas at Arlington. Biftu Mengesha is with the Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco. Nancy F. Berglas is with Advancing New Standards in Reproductive Health, University of California, San Francisco, Oakland, CA
| | - Teresa DePiñeres
- Jill Barr-Walker is with ZSFG Library, University of California, San Francisco, and the Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco. Teresa DePiñeres is with Innovations in Reproductive Health, Miami, FL. Peace Ossom-Williamson is with the UTA Libraries, University of Texas at Arlington. Biftu Mengesha is with the Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco. Nancy F. Berglas is with Advancing New Standards in Reproductive Health, University of California, San Francisco, Oakland, CA
| | - Peace Ossom-Williamson
- Jill Barr-Walker is with ZSFG Library, University of California, San Francisco, and the Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco. Teresa DePiñeres is with Innovations in Reproductive Health, Miami, FL. Peace Ossom-Williamson is with the UTA Libraries, University of Texas at Arlington. Biftu Mengesha is with the Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco. Nancy F. Berglas is with Advancing New Standards in Reproductive Health, University of California, San Francisco, Oakland, CA
| | - Biftu Mengesha
- Jill Barr-Walker is with ZSFG Library, University of California, San Francisco, and the Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco. Teresa DePiñeres is with Innovations in Reproductive Health, Miami, FL. Peace Ossom-Williamson is with the UTA Libraries, University of Texas at Arlington. Biftu Mengesha is with the Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco. Nancy F. Berglas is with Advancing New Standards in Reproductive Health, University of California, San Francisco, Oakland, CA
| | - Nancy F Berglas
- Jill Barr-Walker is with ZSFG Library, University of California, San Francisco, and the Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco. Teresa DePiñeres is with Innovations in Reproductive Health, Miami, FL. Peace Ossom-Williamson is with the UTA Libraries, University of Texas at Arlington. Biftu Mengesha is with the Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco. Nancy F. Berglas is with Advancing New Standards in Reproductive Health, University of California, San Francisco, Oakland, CA
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Conceptualizing Pain and Personhood in the Periviable Period: Perspectives from Reproductive Health and Neonatal Intensive Care Unit Clinicians. Soc Sci Med 2020; 269:113558. [PMID: 33298385 DOI: 10.1016/j.socscimed.2020.113558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/24/2020] [Accepted: 11/27/2020] [Indexed: 10/22/2022]
Abstract
In 2020, the Pain Capable Unborn Child Protection Act was brought to an unsuccessful Senate vote for the third time in five years. The Act seeks to prohibit abortions after 20 weeks post-conception based on the scientifically contested claim that fetuses are at that point capable of feeling pain. It thus seeks to undermine Roe v. Wade's viability standard by asserting that the capacity for pain perception is sufficient for "compelling governmental interest" in fetal life. The ability of many NICUs to offer life-sustaining interventions for periviable neonates means that, in many states, neonatologists and physicians who provide second-trimester abortion care may manage cases of the same gestational age. Given this overlap, this qualitative study examines how clinicians think about the capacity of periviable entities to feel pain and how these ideas shape clinical practice and understandings of compassionate care. Drawing on twenty semi-structured interviews conducted between June 2019 and April 2020 with clinicians providing second-trimester abortion care and NICU care in the Northeast United States, it examines how pain is "known" in the periviable period and how clinicians think about pain in relationship to personhood. A key finding is that the meaning of pain and implications for clinical care is shaped by the anticipated futures and personhood status of periviable entities as determined by pregnant people and families of neonates. Clinicians also stated that concerns around the alleviation of suffering, defined as long-term or chronic distress for pregnant people and/or neonates and their families, were more pressing than the potential experience of short-term physical pain. Legislative attempts to make contested ideas of "fetal pain" the basis for "governmental interest" ignores other forms of suffering that might result from denial of options, and potentially places clinicians at odds with their own conceptions of competent and compassionate care.
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Witwer E, Jones RK, Fuentes L, Castle SK. Abortion service delivery in clinics by state policy climate in 2017. Contracept X 2020; 2:100043. [PMID: 33083783 PMCID: PMC7561526 DOI: 10.1016/j.conx.2020.100043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/01/2020] [Accepted: 10/03/2020] [Indexed: 10/30/2022] Open
Abstract
Objective The objective was to examine service delivery in clinics that provided abortions in 2017, including differences by abortion policy climate. Study design Using data from the Guttmacher Institute's 2017 Abortion Provider Census, we examine amount charged for abortion care, pregnancy gestation at which abortions were offered, number of days per week that clinics provided abortions and types of nonabortion services offered. Our analysis focuses on the 808 clinic facilities that provided 95% of abortions that year. Measures were calculated nationally and according to whether the clinic was in a state we categorized as hostile, middle ground or supportive of abortion rights. Results In 2017, 64% of clinics offered abortion at 11 weeks pregnancy gestation, and 22% did so at 20 weeks gestation. Supportive states had a higher density of clinics that provide abortion for every measured gestation than hostile states. Clinics charged an average of $549 for a surgical abortion at 10 weeks and $551 for medication abortion. Some 46% of clinics in supportive states offered abortion care 5 or more days per week compared to 29% in hostile states. Most clinics offered standalone contraception and family planning (87%) and gynecological care (85%), but the proportion of clinics that provided these services was higher in supportive states (93% and 90%) than in hostile states (75% and 73%). Conclusions A substantial proportion of abortion facilities provide a range of other health care services. Aspects of service delivery, such as number of days abortions are provided, may vary according to abortion policy climate. Implications statement Onerous policies in states hostile to abortion rights may inhibit some facilities from providing abortion more days per week, and if so, could further burden patients obtaining abortion care in these states.
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Affiliation(s)
- Elizabeth Witwer
- Guttmacher Institute, 125 Maiden Lane, Seventh Floor, New York, NY 10038
| | - Rachel K Jones
- Guttmacher Institute, 125 Maiden Lane, Seventh Floor, New York, NY 10038
| | - Liza Fuentes
- Guttmacher Institute, 125 Maiden Lane, Seventh Floor, New York, NY 10038
| | - S Kate Castle
- Guttmacher Institute, 125 Maiden Lane, Seventh Floor, New York, NY 10038
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Brassfield ER, Buchbinder M. Clinicians' Perspectives on the Duty to Inform Patients About Medical Aid-in-Dying. AJOB Empir Bioeth 2019; 11:53-62. [PMID: 31829903 DOI: 10.1080/23294515.2019.1695016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background: As of 2019, ten jurisdictions in the United States have authorized physicians to prescribe a lethal dose of medication to a terminally ill patient for the purpose of hastening death. Relatively little bioethics scholarship has addressed the question of whether physicians have an obligation to inform qualifying patients about aid-in-dying (AID) in permissive jurisdictions and little is known about providers' actual communication practices with respect to this issue. Methods: One hundred and forty-four in-depth, semi-structured interviews were conducted and analyzed using an inductive analytic approach as part of the Vermont Study on Aid-in-Dying. Results: Seventeen respondents, 14 physicians and 3 nurse practitioners, met the inclusion criteria for this sub-study. Eleven respondents indicated that they at least sometimes inform patients about AID. Respondents described multiple factors that influence whether or not they might initiate discussions of AID, including the importance of informing patients of their options for end-of-life care, worries about undue influence, and worries about the potential effects on the patient-provider relationship. For those providers who do initiate discussion of AID at least some of the time, attention to the particulars of each individual patient's situation and the context of the discussion appear to play a role in shaping communication about AID. Conclusions: While initiating a clinical discussion of AID is undoubtedly challenging, our study provides compelling descriptive evidence that some medical providers who support AID do not unilaterally follow the conventional bioethics wisdom holding that they ought to wait for patients to introduce the topic of AID. Future research should investigate how to approach these discussions so as to minimize ethical worries about undue influence or potential negative consequences.
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Affiliation(s)
- Elizabeth R Brassfield
- Department of Philosophy and School of Medicine, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Mara Buchbinder
- Center for Bioethics, Department of Social Medicine, School of Medicine, University of North Carolina at Chapel Hill, North Carolina, USA
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Health Care Providers' Experiences with Implementing Medical Aid-in-Dying in Vermont: a Qualitative Study. J Gen Intern Med 2019; 34:636-641. [PMID: 30684201 PMCID: PMC6445925 DOI: 10.1007/s11606-018-4811-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 10/22/2018] [Accepted: 12/06/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND The evolving legal landscape for medical aid-in-dying (AID) in the USA raises clinical and public health challenges and concerns regarding how health care providers will accommodate AID while expanding access to high-quality end-of-life care. OBJECTIVE To describe Vermont health care providers' experiences practicing under the "Patient Choice and Control at End of Life" Act. DESIGN Qualitative semi-structured interviews analyzed using grounded theory. PARTICIPANTS The larger study included 144 health care providers, terminally ill patients, caregivers, policy stakeholders, and other Vermont residents working in 10 out of Vermont's 14 counties. This article reports on a subset of 37 providers who had clinical experience with the law. MAIN MEASURES Themes from interviews. KEY RESULTS Physicians were roughly split between hospital and community-based practices. Most were women (68%) and the largest subgroup specialized in internal or family medicine (53%). Most of the nurses and social workers were women (89%) and most worked for hospice and home health agencies (61%). We identified five domains in which participants engaged with AID: (1) clinical communication and counseling; (2) the Act 39 protocol; (3) prescribing medication; (4) planning for death; and (5) professional education. How providers experienced these five domains of clinical practice depended on their practice setting and the supportive resources available. CONCLUSION Health care providers' participation in AID involves clinical tasks outside of responding to patients' requests and writing prescriptions. Research to identify best practices should focus on all domains of clinical practice in order to best prepare providers.
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Affiliation(s)
- Lynn M. Morgan
- Department of Sociology and Anthropology, Mount Holyoke College, South Hadley, Massachusetts, USA
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Frarey A, Schreiber C, McAllister A, Shaber A, Sonalkar S, Sammel MD, Long JA. Pathways to Abortion at a Tertiary Care Hospital: Examining Obesity and Delays. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2019; 51:35-41. [PMID: 30645011 DOI: 10.1363/psrh.12086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 08/22/2018] [Accepted: 09/18/2018] [Indexed: 06/09/2023]
Abstract
CONTEXT Advancing gestational age can increase the cost of an abortion and is a significant risk factor for complications. While obesity is not associated with increased risks, anecdotal evidence suggests that obese women seeking services at freestanding abortion clinics are often referred for hospital-based care, which can lead to delays. METHODS In 2016, a cross-sectional survey collected data on the experiences of 201 women who had obtained abortions at a hospital-based clinic in Philadelphia; rates of medical complications were determined from hospital records. Multivariable logistic regression analysis was used to assess if obesity was associated with whether patients had been referred from freestanding abortion clinics or reported other paths to care. Differences in wait time and up-front out-of-pocket costs were examined by women's referral status. RESULTS No difference in rates of abortion complications was found between patient groups. Women who were severely obese (body mass index of at least 40 kg/m2 ) were more likely than normal-weight individuals to have been referred from a freestanding abortion clinic (odds ratio, 7.5). The median wait time to get an abortion was 28 days for referred patients and 12 days for others. Multivariable analysis confirmed that referred patients waited twice as long as other patients (rate ratio, 2.0) and paid 66% more in up-front costs. CONCLUSIONS Future research is needed to determine whether obese women seeking abortions are being referred despite evidence that they do not require hospital-based care. If obese women are suffering delays because of referral, strategies to help overcome delay should also be explored.
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Affiliation(s)
- Alhambra Frarey
- Assistant Professor, Department of Obstetrics and Gynecology, The University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Courtney Schreiber
- Associate Professor, Department of Obstetrics and Gynecology, The University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Arden McAllister
- Research Program Manager, Department of Obstetrics and Gynecology, The University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Allison Shaber
- Medical Student, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia
| | - Sarita Sonalkar
- Assistant Professor, Department of Obstetrics and Gynecology, The University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Mary D Sammel
- Professor, Center for Clinical Epidemiology and Biostatistics, The University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Judith A Long
- Professor, Corporal Michael J. Crezenz VA Center for Health Equity Research and Promotion, and Department of Medicine, The University of Pennsylvania Perelman School of Medicine, Philadelphia
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Donnelly KZ, Dehlendorf C, Reed R, Agusti D, Thompson R. Adapting the Interpersonal Quality in Family Planning care scale to assess patient perspectives on abortion care. J Patient Rep Outcomes 2019; 3:3. [PMID: 30666466 PMCID: PMC6340910 DOI: 10.1186/s41687-018-0089-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 12/04/2018] [Indexed: 11/18/2022] Open
Abstract
Background Women value receiving quality interpersonal care during abortion services, yet no measure exists to assess this outcome from patients’ perspectives. We sought to adapt the Interpersonal Quality in Family Planning care scale (Dehlendorf et al., American Journal of Obstetrics Gynaecology 10.1016/j.ajog.2016.01.173, 2016) for use in abortion care. Methods We adapted items from the original scale for the abortion context, and conducted cognitive interviews to explore the acceptability, understandability, and importance of the adapted items. Adults who spoke English and/or Spanish, had an abortion in the past year, and lived in the US were eligible to participate. Interview memos were analyzed concurrently with data collection to refine the measure in stages. Results We interviewed 26 participants. Items were tested over seven stages and led to four main changes. First, we revised three items to reflect concepts perceived as important to the specific decision-making context of abortion. Second, we removed two items that emerged as potentially inappropriate for this context. Third, we modified language in four items to improve their appropriateness for this context (e.g., ‘telling me’ to ‘explaining’; ‘letting me say’ to ‘listening to’). Fourth, we modified language in three items to improve their clarity. Three items remained unchanged, as there was consistent agreement on their importance, understandability, and relevance. Conclusions The resulting 10-item measure, the Interpersonal Quality in Abortion Care scale, was perceived to be highly important, understandable, and feasible to complete. Future psychometric evaluation can prepare it for use in clinical practice to ensure women feel adequately informed and supported during abortion care.
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Affiliation(s)
- Kyla Z Donnelly
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, 1 Medical Drive, Lebanon, NH, 03756, USA.
| | - Christine Dehlendorf
- UCSF Department of Family and Community Medicine, 1001 Potrero Avenue, San Francisco, CA, 94110, USA.,UCSF Department of Epidemiology & Biostatistics, San Francisco, 94158, CA, USA.,UCSF Department of Obstetrics, Gynecology, & Reproductive Sciences, San Francisco, 94158, CA, USA
| | - Reiley Reed
- UCSF Department of Family and Community Medicine, 1001 Potrero Avenue, San Francisco, CA, 94110, USA
| | - Daniela Agusti
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, 1 Medical Drive, Lebanon, NH, 03756, USA
| | - Rachel Thompson
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, 2006, NSW, Australia
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Buchbinder M. Access to Aid-in-Dying in the United States: Shifting the Debate From Rights to Justice. Am J Public Health 2018; 108:754-759. [PMID: 29672149 PMCID: PMC5944872 DOI: 10.2105/ajph.2018.304352] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2018] [Indexed: 12/12/2022]
Abstract
Much of the literature on aid-in-dying (AID) has drawn heavily on rights-based ethical and legal frameworks that emphasize patients' rights of self-determination in end-of-life decision-making. Less attention has focused on how terminally ill people actually experience such putative rights once they are legally authorized. This analytic essay draws on findings from the Vermont Study on Aid-in-Dying, an ethnographic study of the implementation of AID in Vermont (2015-2017). First, I show that terminally ill people can face a range of barriers to accessing AID in permissive jurisdictions, and that access to AID is mediated by various inequalities endemic to US health care, as well as some that are unique to AID. I then build on these findings to examine the utility of the concept of justice for public health scholarship on AID. By integrating empirical, ethical, and policy analysis, I reframe rights-based frameworks that emphasize the role of individual choice and decision-making at the end of life. In doing so, I draw attention to health care justice as a neglected issue in public health perspectives on AID.
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Affiliation(s)
- Mara Buchbinder
- Mara Buchbinder is with the Department of Social Medicine and the Center for Bioethics, University of North Carolina at Chapel Hill (UNC)
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Jones RK, Ingerick M, Jerman J. Differences in Abortion Service Delivery in Hostile, Middle-ground, and Supportive States in 2014. Womens Health Issues 2018; 28:212-218. [PMID: 29339010 PMCID: PMC5959790 DOI: 10.1016/j.whi.2017.12.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 11/20/2017] [Accepted: 12/11/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVES In 2013, the majority of women lived in states considered hostile to abortion rights, or states with numerous abortion restrictions. By comparison, 31% lived in supportive states. This study examined differences in abortion service delivery according to the policy climate in which clinics must operate. METHODS Data come from the 2014 Abortion Provider Census, which contains information about all known abortion-providing facilities in the United States. In addition to number and type of facility, we examine several aspects of abortion care: provision of only early medication abortion (EMA-only), whether an advanced practice clinician provided abortions, gestational parameters, and average charge for procedure. All indicators were examined nationally and according to whether the clinic was in a state that was hostile, middle ground, or supportive of abortion rights. RESULTS In 2014, hostile and supportive states accounted for the same proportion of all U.S. abortions-44% (each)-although 57% of women age 15 to 44 lived in hostile states. Hostile states had one-half as many abortion-providing facilities as supportive ones. EMA-only facilities accounted for 37% of clinics in supportive states compared with 8% in hostile states. Sixty-five percent of clinics in supportive states reported that advanced practice clinicians provided abortion care, compared with 3% in hostile states. After cost of living adjustments, a first-trimester surgical abortion was most expensive in middle-ground states ($470) and least expensive in supportive states ($402). CONCLUSIONS The distribution of abortion services, the type of facility in which they are provided, and the amount a facility charges all vary according to the abortion policy climate.
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A randomized pilot evaluation of individual-level abortion stigma resulting from Pennsylvania mandated abortion counseling. Contraception 2017; 96:227-232. [DOI: 10.1016/j.contraception.2017.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 06/21/2017] [Accepted: 06/27/2017] [Indexed: 11/21/2022]
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Izugbara CO, Egesa CP, Kabiru CW, Sidze EM. Providers, Unmarried Young Women, and Post-Abortion Care in Kenya. Stud Fam Plann 2017; 48:343-358. [PMID: 28940208 PMCID: PMC6681013 DOI: 10.1111/sifp.12035] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Young women and girls in Kenya face challenges in access to abortion care services. Using in‐depth and focus group interviews, we explored providers’ constructions of these challenges. In general, providers considered abortion to be commonplace in Kenya; reported being regularly approached to offer abortion‐related care and services; and articulated the structural, contextual, and personal challenges they faced in serving young post‐abortion care (PAC) patients. They also considered induced abortion among young unmarried girls to be especially objectionable; stressed premarital fertility and out‐of‐union sexual activity among unmarried young girls as transgressive of respectable femininity and proper adolescence; blamed young women and girls for the challenges they reported in obtaining PAC services; and linked these challenges to young women's efforts to conceal their failures related to gender and adolescence, exemplified by pre‐marital pregnancy and abortion. This study shows how providers’ distinctive emphasis that young abortion care‐seekers are to blame for their own difficulties in accessing PAC may add to the ongoing crisis of post‐abortion care for young women and adolescent girls in Kenya.
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Donnelly KZ, Elwyn G, Thompson R. Quantity over quality-Findings from a systematic review and environmental scan of patient decision aids on early abortion methods. Health Expect 2017; 21:316-326. [PMID: 28881071 PMCID: PMC5750699 DOI: 10.1111/hex.12617] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2017] [Indexed: 12/25/2022] Open
Abstract
Background The availability and effectiveness of decision aids (DAs) on early abortion methods remain unknown, despite their potential for supporting women's decision making. Objective To describe the availability, impact and quality of DAs on surgical and medical early abortion methods for women seeking induced abortion. Search strategy For the systematic review, we searched MEDLINE, Cochrane Library, CINAHL, EMBASE and PsycINFO. For the environmental scan, we searched Google and App Stores and consulted key informants. Inclusion criteria For the systematic review, we included studies evaluating an early abortion method DA (any format and language) vs a comparison group on women's decision making. DAs must have met the Stacey et al (2014). Cochrane review definition of DAs. For the environmental scan, we included English DAs developed for the US context. Data extraction and synthesis We extracted study and DA characteristics, assessed study quality using the Effective Practice and Organization of Care risk of bias tool and assessed DA quality using International Patient Decision Aid Standards (IPDAS). Results The systematic review identified one study, which found that the DA group had higher knowledge and felt more informed. The evaluated DA met few IPDAS criteria. In contrast, the environmental scan identified 49 DAs created by non‐specialists. On average, these met 28% of IPDAS criteria for Content, 22% for Development and 0% for Effectiveness. Conclusions Research evaluating DAs on early abortion methods is lacking, and although many tools are accessible, they demonstrate suboptimal quality. Efforts to revise existing or develop new DAs, support patients to identify high‐quality DAs and facilitate non‐specialist developers' adoption of best practices for DA development are needed.
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Affiliation(s)
- Kyla Z Donnelly
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Rachel Thompson
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
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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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Britton LE, Mercier RJ, Buchbinder M, Bryant AG. Abortion providers, professional identity, and restrictive laws: A qualitative study. Health Care Women Int 2016; 38:222-237. [DOI: 10.1080/07399332.2016.1254218] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Laura E. Britton
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Rebecca J. Mercier
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mara Buchbinder
- Department of Social Medicine and Center for Bioethics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Amy G. Bryant
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Buchbinder M. Scripting Dissent: US Abortion Laws, State Power, and the Politics of Scripted Speech. AMERICAN ANTHROPOLOGIST 2016. [DOI: 10.1111/aman.12680] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Mara Buchbinder
- Department of Social Medicine, Center for Bioethics; University of North Carolina at Chapel Hill; Chapel Hill NC 27599
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Buchbinder M, Lassiter D, Mercier R, Bryant A, Lyerly AD. Reframing Conscientious Care: Providing Abortion Care When Law and Conscience Collide. Hastings Cent Rep 2016; 46:22-30. [PMID: 27120281 PMCID: PMC5013255 DOI: 10.1002/hast.545] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Much of the debate on conscience has addressed the ethics of refusal: the rights of providers to refuse to perform procedures to which they object and the interests of the patients who might be harmed by their refusals. But conscience can also be a positive force, grounding decision about offering care.
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Affiliation(s)
- Mara Buchbinder
- Department of Social Medicine, Center for Bioethics, University of North Carolina at Chapel Hill, 333 S. Columbia St., 341A MacNider Hall CB 7240, Chapel Hill, NC 27599,
| | - Dragana Lassiter
- Department of Anthropology, University of North Carolina at Chapel Hill, 301 Alumni Building, CB 3115, Chapel Hill, NC 27510
| | - Rebecca Mercier
- Department of Obstetrics and Gynecology, Jefferson Medical College, 833 Chestnut Street, 1st Floor Philadelphia, PA 19107
| | - Amy Bryant
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, 4002 Old Clinic Building, CB 7570, Chapel Hill, NC 27514
| | - Anne Drapkin Lyerly
- Department of Social Medicine, Center for Bioethics, University of North Carolina at Chapel Hill, 333 S. Columbia St., 333 MacNider Hall CB 7240, Chapel Hill, NC 27599
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Mercier RJ, Buchbinder M, Bryant A. TRAP laws and the invisible labor of US abortion providers. CRITICAL PUBLIC HEALTH 2015; 26:77-87. [PMID: 27570376 DOI: 10.1080/09581596.2015.1077205] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Targeted Regulations of Abortion Providers (TRAP laws) are proliferating in the United States and have increased barriers to abortion access. In order to comply with these laws, abortion providers make significant changes to facilities and clinical practices. In this article, we draw attention to an often unacknowledged area of public health threat: how providers adapt to increasing regulation, and the resultant strains on the abortion provider workforce. Current US legal standards for abortion regulations have led to an increase in laws that target abortion providers. We describe recent research with abortion providers in North Carolina to illustrate how providers adapt to new regulations, and how compliance with regulation leads to increased workload and increased financial and emotional burdens on providers. We use the concept of invisible labor to highlight the critical work undertaken by abortion providers not only to comply with regulations, but also to minimize the burden that new laws impose on patients. This labor provides a crucial bridge in the preservation of abortion access. The impact of TRAP laws on abortion providers should be included in the consideration of the public health impact of abortion laws.
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Affiliation(s)
- Rebecca J Mercier
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia PA 19107 United States
| | - Mara Buchbinder
- Department of Social Medicine, University of North Carolina at Chapel Hill, 341A MacNider Hall CB 7240, Chapel Hill, NC 27599 United States
| | - Amy Bryant
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, 4002 Old Clinic Building, CB 7570, Chapel Hill, NC 27599 United States
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