Abortion in the United States

Protocol for Increasing the Sensitivity of MS-Based Protein Detection in Human Chorionic Villi

An important step in the proteomic analysis of missing proteins is the use of a wide range of tissues, optimal extraction, and the processing of protein material in order to ensure the highest sensitivity in downstream protein detection. This work describes a purification protocol for identifying low-abundance proteins in human chorionic villi using the proposed “1DE-gel concentration” method. This involves the removal of SDS in a short electrophoresis run in a stacking gel without protein separation. Following the in-gel digestion of the obtained holistic single protein band, we used the peptide mixture for further LC–MS/MS analysis. Statistically significant results were derived from six datasets, containing three treatments, each from two tissue sources (elective or missed abortions). The 1DE-gel concentration increased the coverage of the chorionic villus proteome. Our approach allowed the identification of 15 low-abundance proteins, of which some had not been previously detected via the mass spectrometry of trophoblasts. In the post hoc data analysis, we found a dubious or uncertain protein (PSG7) encoded on human chromosome 19 according to neXtProt. A proteomic sample preparation workflow with the 1DE-gel concentration can be used as a prospective tool for uncovering the low-abundance part of the human proteome.

Digital Multisided Platforms and Women’s Health: An Empirical Analysis of Peer-to-Peer Lending and Abortion Rates

Access to short-term capital remains a pressing problem for many people, especially those facing medical emergencies or needing immediate care. Peer-to-peer lending platforms have the ability to resolve these capital constraints by providing access to small to medium sums of money in an environment that is private and protective of personal information. In this study, we consider how the introduction of P2P lending platforms, and the resulting access to capital, influences local abortion rates, a medical procedure characterized by significant financial barriers and social stigma. We find that the entry of the P2P platform LendingClub is associated with an increase in the rate at which women choose to not carry to term. We argue that the availability of capital through these platforms, when combined with privacy protections, is able to reduce the financial barriers women face when accessing abortion services. This observed effect is stronger in more religious areas and areas with lower levels of education, indicating that social frictions and stigma may be higher in these areas, and also showing where providing an additional channel for funding is more influential.

The Association Between Intimate Partner Violence and Distance Traveled to Access Abortion in a Nationally Representative Sample of Abortion Patients

The objective of this article is to describe a secondary data analysis of the 2008 Abortion Patient Survey (APS 2008) data exploring the association between intimate partner violence (IPV) and travel distances in a national sample of patients seeking abortion services in the United States. The researchers used the 2008 APS, which is the most recent publicly available version of this dataset, to conduct chi-square tests to examine the bivariate associations between all independent and dependent variables. Prevalence ratios were calculated to determine the association between physical and sexual violence and distance traveled to get an abortion, controlling for length of pregnancy, age, education, income, poverty category, race, relationship status, insurance type, whether women went to the closest clinic, whether the pregnancy was wanted, and number of previous abortions. Results indicate that approximately 83% of the women traveled between 1 and 50 miles, 11% traveled between 51 and 100 miles, 4% traveled between 101 and 150 miles, and 3% traveled more than 151 miles to get an abortion. Prevalence ratios (PR) reveal that physical violence was significantly associated with distance traveled to get an abortion (PR = 1.15, p < .05) when all control variables were accounted for. Patients in abusive relationships that involve physical violence may have to travel longer distances to access abortion. Repeal of policy that impedes access to abortion is recommended.

No Exceptions: Documenting the Abortion Experiences of US Peace Corps Volunteers

Since 1979, US federal appropriations bills have prohibited the use of federal funds from covering abortion care for Peace Corps volunteers. There are no exceptions; unlike other groups that receive health care through US federal funding streams, including Medicaid recipients, federal employees, and women in federal prisons, abortion care is not covered for volunteers even in cases of life endangerment, rape, or incest. We interviewed 433 returned Peace Corps volunteers to document opinions of, perceptions about, and experiences with obtaining abortion care. Our results regarding the abortion experiences of Peace Corps volunteers, especially those who were raped, bear witness to a profound inequity and show that the time has come to lift the "no exceptions" funding ban on abortion coverage.

Knowledge of termination of pregnancy (TOP) legislation and attitudes toward TOP clinical training among medical students attending two South African universities

Provision of safe, voluntary, termination of pregnancy (TOP) in South Africa is challenged by an insufficient number of TOP-trained clinicians. Medical students' understanding of TOP legality and their attitudes toward TOP training are indicators for future service provision. We administered a 63-item questionnaire to explore these issues at the University of Cape Town and Walter Sisulu University. Ordinary least squares regression assessed predictors of TOP legislation knowledge and training attitudes.

RESULTS

Of 1308 students, 95% knew that TOP was legal in South Africa, but few (27%) understood the specific provisions of the legislation beyond 13 weeks' gestation. Sixty-three percent desired more information about TOP. In multivariate models, female, white and sexually experienced students and students more advanced in school had better legislation knowledge (all p < .01). Attending religious services regularly (p < .01) was associated with lack of support for TOP training, whereas being in a relationship (p < .01) was associated with support for TOP training.

Socioeconomic disparities among ever-married Turkish women who had unintended pregnancies and abortions in a middle Anatolian city

Researchers undertook a cross-sectional study to examine socioeconomic disparities, unintended pregnancies, and decisions about induced abortions among ever-married women in the urban area of Sivas, Turkey. The data for the present study were gathered from a randomly-selected, household-based probability sample of 1,264 ever-married Turkish women. Unintended pregnancies accounted for 46.2% of total pregnancies and, of these, 30% ended in induced abortion. The proportion of induced abortion among all pregnancies was 21.7%. Multiple logistic regression analyses with adjusted odds ratios (aOR) showed that being aged less than 35 years (aOR = 2.14, p < 0.001), having less than a high school education (aOR = 2.18, p < 0.001), being unemployed (aOR = 2.77, p < 0.001), having more than three children (aOR = 1.54, p = 0.006), and having lower income (aOR = 2.11, p < 0.001) were associated with unintended pregnancies. Among women with unintended pregnancy, having more than three children (aOR = 3.06, p < 0.001), lower income (aOR = 3.39, p < 0.001), and age less than 35 years (aOR = 2.57, p < 0.001) were associated with induced abortion. These findings suggest that lower socioeconomic status was associated with induced abortion among women facing an unintended pregnancy. Women who experience unintended pregnancies, who have lower socioeconomic status and education level, should be the target group for midwives and other relevant healthcare providers for educational efforts regarding family planning and contraception.

Effect of abortion protesters on women's emotional response to abortion

BACKGROUND

Little is known about women's experiences with and reactions to protesters and how protesters affect women's emotional responses to abortion.

STUDY DESIGN

We interviewed 956 women seeking abortion between 2008 and 2010 at 30 U.S. abortion care facilities and informants from 27 of these facilities.

RESULTS

Most facilities reported a regular protester presence; one third identified protesters as aggressive towards patients. Nearly half (46%) of women interviewed saw protesters; of those, 25% reported being "a little" upset, and 16% reported being "quite a lot" or "extremely" upset. Women who had difficulty deciding to abort had higher odds of reporting being upset by protesters. In multivariable models, exposure to protesters was not associated with differences in emotions 1 week after the abortion.

CONCLUSION

Protesters do upset some women seeking abortion services. However, exposure to protesters does not seem to have an effect on women's emotions about the abortion 1 week later.

Medication abortions among New York City residents, 2001-2008

CONTEXT

Population-level research on trends in medication abortions and the association of patient characteristics and facility type with procedure choice is limited. Surveillance is necessary to ensure accurate reporting and understanding of service availability.

METHODS

New York City induced abortion data for 2001-2008 were used to calculate medication abortion prevalence among women undergoing early abortions (i.e., at nine or fewer weeks of gestation). Multiple logistic regression analysis was used to assess associations between selected characteristics and having a medication, as opposed to surgical, abortion. Proportions of patients who went to clinics or hospitals that did not offer medication abortions were also calculated.

RESULTS

Five percent of early abortions were medication procedures in 2001; the proportion rose to 13% by 2008. Eighty-two percent of medication abortions in 2008 were performed at freestanding clinics, and 10% at doctors' offices. The likelihood of having had a medication abortion, rather than a surgical one, was lower among blacks and Hispanics than among whites (odds ratios, 0.5 and 0.7, respectively). Medication abortions were more likely among women with more than 12 years of education than among those with less than a high school education (2.1), and more likely among those who went to doctors' offices than among clinic patients (3.6). Throughout 2001-2008, medication abortions were not available at 50% of hospitals and 31% of clinics that provided early abortions.

CONCLUSIONS

The increasing prevalence of medication abortions highlights the importance of active surveillance. Because many facilities do not offer the procedure, a better understanding of barriers to provision is needed.

Access to safe and legal abortion for teenage women from deprived backgrounds in Hong Kong

This paper reports on a qualitative study in 2007-08 on the abortion experiences of teenage women from deprived backgrounds in Hong Kong. Twenty-nine young women aged 13-24 who had undergone one or more induced abortions in their teen years were interviewed and participated in group empowerment sessions. Ten were unemployed, four were students, the rest were employed on low pay in unskilled occupations. Abortion services are legal and available in public and private services, but they charge fees ranging from HK$310 to $10,000, and do abortions only up to 24 weeks of pregnancy. Many young women resort to poor quality illegal clinics and clinics in mainland China because the cost is lower, they do not wish to tell their parents, who would be asked for consent, and/or they want to protect their sex partners, who may be reported and prosecuted if the girl is under-age. There is a need to strengthen services for teenage women in Hong Kong, especially those who are pregnant and from deprived backgrounds. There is also a need for professionals who deliver adolescent health and social welfare services, and for society to rethink and re-examine its views and attitudes towards teenage pregnancy, sexuality and abortion.

Obstacles to the integration of abortion into obstetrics and gynecology practice

CONTEXT

Obstetrics and gynecology residents who are trained in family planning and intend to provide abortions after residency often do not ultimately do so. The extent of the professional barriers physicians face trying to integrate abortion into their practice is unknown.

METHODS

In 2006, in-depth interviews were conducted with 30 obstetrician-gynecologists who had graduated 5-10 years earlier from residency programs that included abortion training. Interviews about physicians' experiences with abortion training and practice were coded and analyzed using a grounded theoretical approach.

RESULTS

Eighteen physicians had wanted to offer elective abortions after residency, but only three were doing so at the time of the interview. The majority were unable to provide abortions because of formal and informal policies imposed by their private group practices, employers and hospitals, as well as the strain that doing so might put on relationships with superiors and coworkers. Restrictions on abortion provision sometimes were made explicit when new physicians interviewed for a job, but sometimes became apparent only after they had joined a practice or institution. Several physicians mentioned the threat of violence as an obstacle to providing abortions, but few considered this the greatest deterrent.

CONCLUSIONS

The stigma and ideological contention surrounding abortion manifest themselves in professional environments as barriers to the integration of abortion into medical practice. New physicians often lack the professional support and autonomy necessary to offer abortion services.

Understanding the effects of personal and school religiosity on the decision to abort a premarital pregnancy

Although much research has examined the relationship between religion and abortion attitudes, few studies have examined whether religion influences abortion behavior. This study looks at whether individual and school religiosity influence reported abortion behavior among women who become pregnant while unmarried. Hierarchical Logistic Models are implemented to analyze two waves of data from the National Longitudinal Study of Adolescent Health. Findings show that personal religiosity is unrelated to reported abortion behavior. However, conservative Protestants appear less likely to obtain abortions than mainline Protestants, Catholics, and women of non-Christian faiths. Regardless of personal religious affiliation, having attended a school with a high proportion of conservative Protestants appears to discourage abortion as women enter their twenties. Conversely, women from private religious high schools appear more likely to report obtaining an abortion than women from public schools.

The effects of religious contextual norms, structural constraints, and personal religiosity on abortion decisions

Researchers have established that individual religiosity influences abortion attitudes, and that abortion attitudes, in turn, shape abortion restrictions and access. Less clear is whether religion and abortion structural constraints influence abortion decisions. This study examines the several individual, contextual, and structural factors that could shape the abortion decisions of women who conceive before marriage. Special attention is given to the importance of academic aspirations and structural constraints, in contrast to religious beliefs and county religious context, for making an abortion decision. Hierarchical modeling techniques and two waves of data from the National Longitudinal Study of Adolescent Health (Add Health) are employed. Neither generic religiosity nor conservative Protestant religious context appear to influence women's abortion decisions. Conversely, young women's abortion decisions are shaped by academic ambition, identification with a conservative Protestant denomination, proximity to an abortion clinic and the level of public abortion funding in their county of residence.

Determinants of demand: method selection and provider preference among US women seeking abortion services

BACKGROUND

Medication abortion has the potential to increase abortion availability, primarily through new provider networks; however, without a better understanding of how and why women make decisions regarding both their abortion method and their provider, expansion efforts may be misguided and valuable resources may be wasted.

STUDY DESIGN

We undertook an exploratory study to investigate method and provider preferences. Semistructured one-on-one interviews were conducted with 205 abortion clients at three family planning clinics.

RESULTS

Study participants greatly preferred the clinic setting for their abortion; the majority of women in the study would not have gone to their regular physician if they had been given the option. In addition, method choice trumps provider choice for the majority of women who would have preferred their regular provider. Participants who chose the aspiration procedure were more likely to have previous knowledge about the medication method. Travel time was not a predictor of preferring one's regular physician over the clinic.

CONCLUSIONS

Expanding provider networks via the private sector is unlikely to be a panacea. In addition to these efforts, more attention may need to be paid to addressing logistic barriers to access. Physicians offering abortion services need to let their patients know they offer such services prior to their patients' need for them. Questions remain regarding the information being circulated about medication abortion.

Socioeconomic inequalities in unintended pregnancy and abortion decision

Pregnancy planning allows women to better control their life trajectory and contributes to the future child's health and development. Many studies that have analyzed socioeconomic inequalities in unintended pregnancy only took into account those pregnancies ending in births. Few of them that analyzed unintended pregnancy, including both induced abortion and births, and its socioeconomic determinants, concluded that unintended pregnancy is more frequent in young, poor, or unmarried women. These inequalities have been poorly studied in Europe, especially in the southern European context. The aim of the present study is to describe socioeconomic inequalities in unintended pregnancy and in abortion decision in Barcelona, Spain. The major findings are that unintended pregnancies accounted for 41% of total pregnancy and of these, 60% ended in abortion. From all pregnancies, the proportion of induced abortion reached 25.6%. Compared to women with university studies, those with primary education incomplete had more unintended pregnancies (OR=7.22). When facing an unintended pregnancy, women of lower socioeconomic position are more likely to choose induced abortion, although this is not the case among young or single women. This study reveals deep socioeconomic inequalities in unintended pregnancies and abortion decision in Barcelona, Spain, where the birth rate is very low and the abortion rate is rising. Women in low socioeconomic positions have many more unintended pregnancies than better educated women. Except for young or single women, the lower the socioeconomic position, the higher the proportion of women who choose an induced abortion when facing an unintended pregnancy.

The Role of Advanced Practice Clinicians in the Availability of Abortion Services in the United States

Although abortion is one of the most common surgical procedures performed in the United States, the number of abortion providers is declining. Advanced practice clinicians, including nurse practitioners and certified nurse-midwives, may help to alleviate this shortage. However, some states bar nonphysicians from performing abortions. Not only should training in abortion techniques be made available to nonphysician providers who desire it, but legal obstacles must also be overcome in order to allow advanced practice clinicians the right to provide abortion services.