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Allison BA, Vear K, Hoopes AJ, Maslowsky J. The Perceived Impact of a Post-Dobbs Landscape on U.S. Adolescents and Young Adults. Contraception 2024:110513. [PMID: 38879071 DOI: 10.1016/j.contraception.2024.110513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 06/05/2024] [Accepted: 06/10/2024] [Indexed: 06/20/2024]
Abstract
OBJECTIVE(S) To capture the perspectives and knowledge of adolescents and young adults on abortion-related topics following the Dobbs decision. STUDY DESIGN Qualitative content analysis of an open-ended, five-question survey fielded on October 28, 2022 via the MyVoice project, a nationwide weekly text message poll of 14-24-year-olds. RESULTS We found the respondents (N=565, response rate 71%) had a mean age of 20.0 years and resided in 47 states. Many described pro- or anti-abortion changes to abortion access in their state, though expressed mixed emotions about the changes (negative, positive, or mixed/neutral). Most often, they had conversations about abortion with peers (28%), followed by parents or family (20%); nearly 20% stated they have never had a conversation about abortion. The majority of respondents (55%) believed they and their peers should have access to abortion care without required parental consent/notification, frequently citing individual rights/autonomy (31%) followed by harms of parental involvement (12%). Most (79%) provided a technique for how to determine if online information about abortion was trustworthy. CONCLUSION(S) Four months after the Dobbs decision, this national sample of adolescents and young adults were aware of changes to abortion access, had conversations about abortion, shared diverse opinions on parental consent or notification laws, and could determine trustworthiness of online abortion resources. Abortion-related policy and practice can be improved by understanding adolescents' and young adults' needs and preferences, trusting and supporting their autonomy, and reducing barriers to care. IMPLICATIONS STATEMENT This study highlights the timely perspectives and experiences of a diverse, nationwide sample of adolescents and young adults on abortion-related topics. Findings can support centering adolescents and young adults in practice and policy changes to improve their knowledge about abortion and streamline access to essential reproductive health services post-Dobbs.
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Affiliation(s)
- Bianca A Allison
- University of North Carolina School of Medicine, Chapel Hill NC.
| | - Kinsey Vear
- Swedish Cherry Hill Family Medicine Residency Program, Seattle, WA.
| | - Andrea J Hoopes
- Kaiser Permanente Washington Health Research Institute, Seattle WA.
| | - Julie Maslowsky
- University of Michigan School of Public Health, Ann Arbor MI.
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Chiu DW, Braccia A, Jones RK. Characteristics and Circumstances of Adolescents Obtaining Abortions in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:477. [PMID: 38673388 PMCID: PMC11050360 DOI: 10.3390/ijerph21040477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/01/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024]
Abstract
The purpose of this study is to describe the sociodemographic and situational circumstances of adolescents obtaining abortion in the United States prior to the Dobbs decision. We use data from the Guttmacher Institute's 2021-2022 Abortion Patient Survey, a cross-sectional survey of 6698 respondents; our analytic sample includes 633 adolescents (<20 years), 2152 young adults (20-24 years), and 3913 adults (25+ years). We conducted bivariate analyses to describe the characteristics and logistical and financial circumstances of adolescents obtaining abortions in comparison to respondents in the other age groups. The majority of adolescents identified as non-white (70%), and 23% identified as something other than heterosexual. We found that 26% of adolescents reported having no health insurance, and two-thirds of adolescent respondents reported that somebody had driven them to the facility. Adolescents differed from adults in their reasons for delays in accessing care; a majority of adolescents (57%) reported not knowing they were pregnant compared to 43% of adults, and nearly one in five adolescents did not know where to obtain the abortion compared to 11% of adults. Adolescents were more likely than adults to obtain a second-trimester abortion, which has increased costs. This study found that this population was more vulnerable than adults on several measures. Findings suggest that adolescents navigate unique barriers with regard to information and logistics to access abortion care.
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Affiliation(s)
- Doris W. Chiu
- Guttmacher Institute, New York, NY 10038, USA; (A.B.); (R.K.J.)
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de Londras F, Cleeve A, Rodriguez MI, Farrell A, Furgalska M, Lavelanet AF. The impact of third-party authorization requirements on abortion-related outcomes: a synthesis of legal and health evidence. BMC Public Health 2023; 23:2065. [PMID: 37872513 PMCID: PMC10591342 DOI: 10.1186/s12889-023-16307-1] [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: 02/16/2023] [Accepted: 07/13/2023] [Indexed: 10/25/2023] Open
Abstract
OBJECTIVES This review synthesizes legal and health evidence to demonstrate the health and human rights impacts of third-party authorization requirements (TPAs) on abortion seekers. RESULTS The synthesized evidence substantiates the pre-existing position in international human rights law that requirements that abortion be authorized by third parties like parents, spouses, committees, and courts create barriers to abortion, should not be introduced at all, or should be repealed where they exist. CONCLUSIONS The review establishes that rights-based regulation of abortion should not impose TPAs in any circumstances. Instead, the provision and management of abortion should be treated in a manner cognizant with the general principles of informed consent in international human rights law, presuming capacity in all adults regardless of marital status and treatment sought, and recognizing the evolving capacity of young people in line with their internationally-protected rights.
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Affiliation(s)
- Fiona de Londras
- Birmingham Law School, University of Birmingham, B15 2TT, Birmingham, UK.
| | - Amanda Cleeve
- Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
- South General Hospital (Södersjukhuset), Stockholm, Sweden
| | - Maria I Rodriguez
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA
| | - Alana Farrell
- Birmingham Law School, University of Birmingham, B15 2TT, Birmingham, UK
| | | | - Antonella F 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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Ralph L, Hasselbacher L. Adolescents and Abortion Restrictions: Disproportionate Burdens and Critical Warnings. J Adolesc Health 2023; 73:221-223. [PMID: 37455044 DOI: 10.1016/j.jadohealth.2023.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 05/10/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Lauren Ralph
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, Oakland, California
| | - Lee Hasselbacher
- Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health (Ci3), Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois
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Stevenson AJ, Coleman-Minahan K. Use of Judicial Bypass of Mandatory Parental Consent to Access Abortion and Judicial Bypass Denials, Florida and Texas, 2018-2021. Am J Public Health 2023; 113:316-319. [PMID: 36634290 PMCID: PMC9932372 DOI: 10.2105/ajph.2022.307173] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2022] [Indexed: 01/13/2023]
Abstract
Objectives. To describe minors' use of judicial bypass to access abortion and the percentage of bypass petitions denied in Florida and Texas. Methods. Data were derived from official state statistics on judicial bypasses and abortions by age in Texas and Florida; abortions in Texas among minor nonresidents were estimated. In addition, judicial bypass petitions as a percentage of abortions received by minors and judicial bypass denials as a percentage of petitions were calculated. Results. Between 2018 and 2021, minors received 5527 abortions in Florida and an estimated 5220 abortions in Texas. Use of judicial bypass was stable at 14% to 15% in Florida and declined from 14% to 10% in Texas. Among petitions for judicial bypass, denials increased in Florida from 6% to a maximum of 13% and remained stable in Texas at 5% to 7%. Conclusions. Minors' use of judicial bypass in Texas and Florida is substantial. The percentage of denials is higher and increasing in Florida. Public Health Implications. Minors who need confidential abortion care may now be forced to seek judicial bypass far from home. Parental involvement laws in states that do not ban abortion will compound barriers to abortion care. (Am J Public Health. 2023;113(3):316-319. https://doi.org/10.2105/10.2105/AJPH.2022.307173).
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Affiliation(s)
- Amanda Jean Stevenson
- Amanda Jean Stevenson is with the Department of Sociology and the University of Colorado Population Center, University of Colorado, Boulder. Kate Coleman-Minahan is with the College of Nursing, University of Colorado Anschutz Medical Campus, and the University of Colorado Population Center, University of Colorado, Boulder
| | - Kate Coleman-Minahan
- Amanda Jean Stevenson is with the Department of Sociology and the University of Colorado Population Center, University of Colorado, Boulder. Kate Coleman-Minahan is with the College of Nursing, University of Colorado Anschutz Medical Campus, and the University of Colorado Population Center, University of Colorado, Boulder
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Horvath S, Frietsche S. Judicial bypass for minors post- Dobbs. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231219601. [PMID: 38146197 PMCID: PMC10752100 DOI: 10.1177/17455057231219601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 10/19/2023] [Accepted: 11/23/2023] [Indexed: 12/27/2023]
Abstract
State laws that require minors seeking abortion care to notify or obtain consent from a parent or other legal guardian are broadly referred to as parental involvement laws. Judicial bypass allows a minor to petition the court to bypass parental involvement. Even before the Dobbs v Jackson Women's Health Organization decision overturned Roe v Wade on 24 June 2022, 36 states had at least one parental involvement law, making minor access to abortion care even more complex than adult access. Since the Dobbs decision, at least 15 states have completely banned abortion, adding further complexity, geographic barriers, and inequities to the pursuit of reproductive healthcare. In this narrative review and commentary, we explain parental involvement laws and judicial bypass from both a legal and medical perspective, exploring the evolving challenges created by this system in the year post-Dobbs.
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Affiliation(s)
- Sarah Horvath
- Department of Obstetrics and Gynecology, Penn State University College of Medicine, Hershey, PA, USA
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Abstract
The American Academy of Pediatrics reaffirms its position that the rights of adolescents under 18 years of age to confidential care when considering legal medical and surgical abortion therapies should be protected. Most adolescents voluntarily involve parents and other trusted adults in decisions regarding pregnancy termination and should be encouraged to do so when safe and appropriate. The legal climate surrounding abortion law is rapidly becoming more restrictive and threatens to adversely impact adolescents. Mandatory parental involvement, the judicial bypass procedure, and general restrictive abortion policies pose risks to adolescents' health by causing delays in accessing medical care, increasing volatility within a family, and limiting their pregnancy options. These harms underscore the importance of adolescents' access to confidential abortion care. This statement presents a summary of pertinent current information related to the impact of legislation requiring mandatory parental involvement in an adolescent's decision to obtain abortion services.
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Ford CA, Boyer CB, Halpern CT, Katzman DK, Ross DA. The Distinguished Dozen: 2021 Journal of Adolescent Health Articles Making Distinguished Contributions to Adolescent and Young Adult Health. J Adolesc Health 2022; 70:517-520. [PMID: 35305787 DOI: 10.1016/j.jadohealth.2022.01.122] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 10/18/2022]
Affiliation(s)
| | | | | | | | - David A Ross
- Associate Editor, World Health Organization (retired), Geneva, Switzerland
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White K, Narasimhan S, Hartwig SA, Carroll E, McBrayer A, Hubbard S, Rebouché R, Kottke M, Hall KS. Parental Involvement Policies for Minors Seeking Abortion in the Southeast and Quality of Care. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2022; 19:264-272. [PMID: 38736735 PMCID: PMC11086958 DOI: 10.1007/s13178-021-00539-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 05/14/2024]
Abstract
Introduction Thirty-seven states require minors seeking abortion to involve a parent, either through notification or consent. Little research has examined how implementation of these laws affect service delivery and quality of care for those who involve a parent. Methods Between May 2018 and September 2019, in-depth interviews were conducted with 34 staff members involved in scheduling, counseling, and administration at abortion facilities in three Southeastern states. Interviews explored procedures for documenting parental involvement, minors' and parents' reactions to requirements, and challenges with implementation and compliance. Both inductive and deductive codes, informed by the Institute of Medicine's healthcare quality framework, were used in the thematic analysis. Results Parental involvement laws adversely affected four quality care domains: efficiency, patient-centeredness, timeliness, and equity. Administrative inefficiencies stemmed from the extensive documentation needed to prove an adult's relationship to a minor, increasing the time and effort needed to comply with state reporting requirements. If parents were not supportive of their minor's decision, participants felt they had a duty to intervene to ensure the minor's decision and needs remained centered. Staff further noted that delays to timely care accumulated as minors navigated parental involvement and other state mandates, pushing some beyond gestational age limits. Lower income families and those with complex familial arrangements had greater difficulty meeting state requirements. Conclusions Parental involvement mandates undermine health service delivery and quality for minors seeking abortion services in the Southeast. Policy Implications Removing parental involvement requirements would protect minors' reproductive autonomy and support the provision of equitable, patient-centered healthcare.
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Affiliation(s)
- Kari White
- Steve Hicks School of Social Work and Department of Sociology, University of Texas at Austin, TX, Austin, USA
| | - Subasri Narasimhan
- Department of Behavioral, Social, and Health Education Sciences and Center for Reproductive Health Research in the Southeast, Emory University, Atlanta, GA, USA
| | - Sophie A. Hartwig
- Department of Behavioral, Social, and Health Education Sciences and Center for Reproductive Health Research in the Southeast, Emory University, Atlanta, GA, USA
| | - Erin Carroll
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, AL, Birmingham, USA
| | - Alexandra McBrayer
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, AL, Birmingham, USA
| | | | - Rachel Rebouché
- Beasley School of Law, Temple University, Philadelphia, PA, USA
| | - Melissa Kottke
- Department of Gynecology and Obstetrics and Jane Fonda Center, Emory University, Atlanta, GA, USA
| | - Kelli Stidham Hall
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, New York City, NY, USA
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Forced Parental Involvement in Youth Abortion Creates Obstacles to Access, Even With Judicial Bypass. J Adolesc Health 2021; 68:5-6. [PMID: 33349359 DOI: 10.1016/j.jadohealth.2020.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 10/13/2020] [Indexed: 11/23/2022]
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Coleman-Minahan K, Stevenson AJ, Obront E, Hays S. Judicial bypass attorneys' experiences with abortion stigma in Texas courts. Soc Sci Med 2021; 269:113508. [PMID: 33358022 PMCID: PMC7924962 DOI: 10.1016/j.socscimed.2020.113508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/27/2020] [Accepted: 11/05/2020] [Indexed: 11/16/2022]
Abstract
Texas requires pregnant young people under 18 (i.e., minors) seeking abortion without parental consent to go to court with an attorney to petition a judge for permission to obtain abortion. There is a lack of empirical data on the process through which abortion laws stigmatize abortion and on the actors involved. We use data from in-depth qualitative interviews with 19 attorneys who participated in a collective 800 judicial bypass cases to explore what's at stake for multiple actors within a shared social space and how interactions between those actors reproduce stigma. We extend stigma theory to explain how structural abortion restrictions produce stigma at the individual level. We find that to protect their interests in "keeping pregnant minors in," the Texas court system constrains attorneys' ability to represent minors through politicization and stigmatization; attorneys face logistical and emotional challenges, including navigating hostile or ill-informed courts, witnessing court actors humiliate their clients without means of recourse, and experiencing stigma themselves. Although what's most at stake for their clients becomes most at stake for attorneys- helping young people obtain a judicial bypass so they can access abortion and protecting them from humiliation and trauma- they must reconcile their own violation of norms stigmatizing abortion with their consciences' motivation to represent bypass clients and protect their professional identity and career advancement from being "tainted" by taking judicial bypass cases. In order to protect what is at stake for their clients in the context of the highly stigmatized Texas courts, attorneys rationally make trade-offs that protect some stakes while undermining others. Moreover, attorneys' management of experienced stigma and their violation of norms stigmatizing abortion leads some to reproduce abortion stigma in their interactions with minors.
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Affiliation(s)
- Kate Coleman-Minahan
- College of Nursing, University of Colorado Anschutz Medical Campus, USA; University of Colorado Population Center (CUPC), University of Colorado Boulder, 1440 15th Street, CO, 80302, Boulder, USA.
| | - Amanda Jean Stevenson
- University of Colorado Population Center (CUPC), University of Colorado Boulder, 1440 15th Street, CO, 80302, Boulder, USA; Department of Sociology, University of Colorado Boulder, UCB 327 Ketchum 195, CO, 80309, Boulder, USA.
| | - Emily Obront
- Reproductive Psychiatry Clinic of Austin, Austin, TX, USA.
| | - Susan Hays
- Law Office of Susan Hays, P.C., Austin, TX, USA.
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