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Biggs MA, Becker A, Schroeder R, Kaller S, Scott K, Grossman D, Raifman S, Ralph L. Support for criminalization of self-managed abortion (SMA): A national representative survey. Soc Sci Med 2024; 340:116433. [PMID: 38039765 DOI: 10.1016/j.socscimed.2023.116433] [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: 03/17/2023] [Revised: 10/24/2023] [Accepted: 11/12/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE Since the U.S. Supreme Court eliminated the federal right to abortion, there is a heightened need to understand public opinion about the criminalization of people who attempt to end their pregnancies outside the formal healthcare setting, referred to as self-managed abortion (SMA). We assessed U.S. attitudes about whether three forms of SMA should be legal, reported or punished: 1) using abortion pills obtained outside the healthcare system, 2) using other medications, drugs, herbs, or by drinking alcohol, and 3) using traumatic methods (inserting an object in their body or hitting their stomach). METHODS From December 2021 to January 2022, we administered a national probability-based online survey to English- and Spanish-speaking people assigned female (AFAB, ages 15-49) or male at birth (AMAB, ages 18-49) regarding their attitudes about criminalizing SMA, using Ipsos' KnowledgePanel. We estimated weighted proportions and conducted multivariable regression analyses to identify characteristics associated with support for SMA legality and punishment (reporting to authorities, paying a fine or going to jail). RESULTS A total of 7,016 AFAB and 360 AMAB completed the survey. People were less likely (p < .05) to agree that SMA using abortion pills should be illegal (34% of AFAB and 43% of AMAB) than other forms of SMA (36-48%), although over one-fifth were unsure (AFAB, 20-23% and AMAB, 24-27%). People were less likely to agree SMA using abortion pills should be criminalized than SMA using other drugs, medications, herbs, alcohol or by using traumatic methods. In multivariable analyses, AMAB and Christian religion were associated with agreeing that SMA using abortion pills should be illegal; people who identified as Hispanic/Latinx ethnicity and experienced medical mistreatment were less likely to agree SMA with medication abortion pills should be illegal. CONCLUSIONS Public support for criminalizing SMA is complex and varied by SMA method and form of punishment.
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Affiliation(s)
- M Antonia Biggs
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, Oakland, CA, 94612, USA.
| | - Andréa Becker
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, Oakland, CA, 94612, USA; Department of Sociology, Hunter College, City University of New York, 695 Park Ave NY, NY, 10065, USA
| | - Rosalyn Schroeder
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, Oakland, CA, 94612, USA
| | - Shelly Kaller
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, Oakland, CA, 94612, USA
| | - Karen Scott
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, Oakland, CA, 94612, USA; Birthing Cultural Rigor, LLC, Nashville, TN, 37209, USA
| | - Daniel Grossman
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, Oakland, CA, 94612, USA
| | - Sarah Raifman
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, Oakland, CA, 94612, USA
| | - Lauren Ralph
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, Oakland, CA, 94612, USA
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Kramer A, Ti A, Travis L, Laboe A, Ochieng WO, Young MR. The impact of parental involvement laws on minors seeking abortion services: a systematic review. HEALTH AFFAIRS SCHOLAR 2023; 1:qxad045. [PMID: 38756747 PMCID: PMC10986272 DOI: 10.1093/haschl/qxad045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/10/2023] [Accepted: 09/15/2023] [Indexed: 05/18/2024]
Abstract
On June 24, 2022, the US Supreme Court overturned the constitutional right to abortion in Dobbs v Jackson Women's Health Organization. Minors are a vulnerable population with a high risk of unintended pregnancy who are likely to be disproportionately affected by abortion restrictions. Examining the impact of historical abortion restrictions in minors may provide insight into the anticipated effects of the Dobbs decision. This study is a systematic review examining the impact of parental involvement (PI) laws on minors seeking abortion services. Our review suggests an association between PI laws and decreased abortion rates. Parental involvement laws also may increase pregnancy and birth rates and out-of-state travel for abortion procedures and lead to later abortions, although effects appear to be heterogenous.
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Affiliation(s)
- Alisha Kramer
- Department of Gynecology and Obstetrics, Emory University School of Medicine,Atlanta, GA 30322, United States
| | - Angeline Ti
- Family Medicine, Wellstar Hospital,Morrow, GA 30260, United States
| | - Lisa Travis
- Woodruff Health Sciences Center Library, Emory University,Atlanta, GA 30322, United States
| | - Adrienne Laboe
- Department of Obstetrics and Gynecology, Madigan Army Medical Center, Joint Base Lewis-McChord, WA 98431, United States
| | | | - Marisa R Young
- Department of Gynecology and Obstetrics, Emory University School of Medicine,Atlanta, GA 30322, United States
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Verma N, Grossman D. Self-Managed Abortion in the United States. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2023; 12:70-75. [PMID: 37305376 PMCID: PMC9989574 DOI: 10.1007/s13669-023-00354-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2023] [Indexed: 03/09/2023]
Abstract
Purpose of Review This review aims to provide up-to-date information about self-managed abortion in the USA. Recent Findings Evidence indicates that there is growing demand for self-managed abortion in the USA as obstacles to facility-based care increase, especially since the Supreme Court overturned Roe v. Wade. Self-managed abortion with medications is safe and effective. Summary Based on a nationally representative survey, the lifetime prevalence of self-managed abortion in the USA in 2017 was estimated to be 7%. People experiencing barriers to abortion care, including people of color, people with lower incomes, people in states that have restrictive abortion laws, and those living farther from facilities providing abortion care are more likely to attempt self-managed abortion. While people may use a range of methods to self-manage abortion, there is growing use of safe and effective medications, including mifepristone used together with misoprostol and misoprostol used alone; use of traumatic and dangerous methods is rare. While many people attempt to self-manage their abortion because of barriers to facility-based care, others have a preference for self-care because it is convenient, accessible, and private. While the medical risks of self-managed abortion may be few, the legal risks may be significant. Sixty-one people have been criminally investigated or arrested between 2000 and 2020 for allegedly self-managing their abortion or helping someone else do so. Clinicians play an important role in providing evidence-based information and care to patients considering or attempting self-managed abortion, as well as minimizing legal risks.
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Affiliation(s)
- Nisha Verma
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA USA
| | - Daniel Grossman
- Advancing New Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco (UCSF), 1330 Broadway, Suite 1100, Oakland, CA 94612 USA
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Biggs MA, Driver M, Kaller S, Ralph LJ. Unwanted abortion disclosure and social support in the abortion decision and mental health symptoms: A cross-sectional survey. Contraception 2023; 119:109905. [PMID: 36415007 DOI: 10.1016/j.contraception.2022.10.007] [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: 08/12/2022] [Revised: 10/12/2022] [Accepted: 10/19/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To assess the extent of unwanted abortion disclosure and levels of social support in the abortion decision and their association with depression, anxiety, and stress. STUDY DESIGN From January to June 2019, we surveyed people presenting for abortion at four clinics in California, New Mexico, and Illinois regarding their experiences accessing abortion. We used multivariable regression to examine associations between unwanted abortion disclosure and social support in the abortion decision, and symptoms of depression, anxiety and stress. RESULTS Among 1092 people approached, 784 (72% response rate) eligible individuals initiated the survey, and 746 responded to the unwanted abortion disclosure item and were included in analyses. Over one-quarter (27%) told someone they would have preferred not to tell about their decision, mostly due to obstacles getting to the appointment-time to appointment (46%), travel distance (33%), and costs (32%). Three-quarters (74%, n=546) had at least one person in their life who supported the abortion decision "very much"; 20% had someone who supported the decision "not at all." In adjusted analyses, unwanted abortion disclosure was associated with more symptoms of depression (B = 0.62, 95% confidence interval: 0.28, 0.95), anxiety (B = 1.79; 95% CI: 0.76, 2.82) and stress (B = 1.80, 95% CI: 0.64, 1.72). People also had more symptoms of depression and stress when one or more person (B = 0.64; 95% CI: 0.27, 1.02 and B = 0.75, 95% CI: 0.15, 1.35, respectively) or the man involved in the pregnancy (B = 0.67, 95% CI: 0.16, 1.18 and B = 0.96, 95% CI: 0.13, 1.78, respectively) supported their decision "not at all" (vs "very much" support). CONCLUSION Being forced to disclose the abortion decision due to logistical and cost constraints may be harmful to people's mental health. IMPLICATIONS Logistical burdens such as travel, time to access care, and costs needed to access abortion may force people seeking abortion to involve others who are unsupportive in the abortion decision having negative implications for their mental health.
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Affiliation(s)
- M Antonia Biggs
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, United States.
| | - Matthew Driver
- University of Washington, School of Public Health, Department of Epidemiology, Seattle, WA, United States
| | - Shelly Kaller
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, United States
| | - Lauren J Ralph
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, United States
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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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