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Zephyrin L, Ayo-Vaughan M, Bossick A, Noroña-Zhou A, Higginbotham E, Richardson M, Rodriguez H, Bryant A. Stakeholders' Viewpoints on Working to Advance Health Equity. Health Equity 2024; 8:14-25. [PMID: 38304261 PMCID: PMC10833320 DOI: 10.1089/heq.2023.29040.rtd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Affiliation(s)
- Laurie Zephyrin
- Senior Vice President, Advancing Health Equity, The Commonwealth Fund, New York, New York, USA
| | - Morenike Ayo-Vaughan
- Program Officer, Advancing Health Equity, The Commonwealth Fund, New York, New York, USA
| | - Andrew Bossick
- Assistant Scientist, Henry Ford Health, Detroit, Michigan, USA
| | - Amanda Noroña-Zhou
- Assistant Director of Developmental Medicine, University of California, San Francisco, California, USA
| | - Eve Higginbotham
- Vice Dean for Inclusion, Diversity, and Equity, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Molly Richardson
- Visiting Assistant Professor, University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
| | - Hector Rodriguez
- Kaiser Permanente Endowed Professor of Health Policy and Management, University of California, Berkeley, School of Public Health, Berkeley, California, USA
| | - Allison Bryant
- Maternal-Fetal Medicine Specialist, Associate Chief Health Equity Officer, Massachusetts General Hospital, Boston, Massachusetts, USA
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Baker CN. History and Politics of Medication Abortion in the United States and the Rise of Telemedicine and Self-Managed Abortion. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2023; 48:485-510. [PMID: 36693178 DOI: 10.1215/03616878-10449941] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
This article examines the decades-long campaign to increase access to abortion pills in the United States, including advocates' work to win US Food and Drug Administration approval of mifepristone and misoprostol for abortion, the continuing restrictions on mifepristone, and the multiple strategies advocates have pursued to challenge these restrictions, including lobbying the FDA to remove the restrictions, obtaining a limited research exemption from FDA restrictions, and suing the FDA during the COVID-19 pandemic. The article pays particular attention to the influence of research conducted on the safety and efficacy of medication abortion as well as research on the impact of increased availability of abortion pills through telemedicine during the pandemic. The article also addresses self-managed abortion, wherein people obtain and use mifepristone and/or misoprostol outside the formal health care system, and it documents the growing network of organizations providing logistical, medical, and legal support to people self-managing abortion. The article concludes with reflections on the role abortion pills might play in the post-Roe era amid increasingly divergent abortion access trends across different regions of the United States.
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Bossick AS, Painter I, Williams EC, Katon JG. Development of a Composite Risk Index of Reproductive Autonomy Using State Laws: Association With Maternal and Neonatal Outcomes. Womens Health Issues 2023:S1049-3867(23)00075-0. [PMID: 37120364 DOI: 10.1016/j.whi.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 02/17/2023] [Accepted: 03/24/2023] [Indexed: 05/01/2023]
Abstract
OBJECTIVE We developed a composite index to quantify state legislation related to reproductive autonomy and examined its association with maternal and neonatal outcomes. We hypothesized that greater reproductive autonomy would be associated with lower rates of severe maternal morbidity (SMM), pregnancy-related mortality (PRM), preterm birth (PTB), and low birthweight. DESIGN A Delphi panel was used to inform development of the index. Restrictive policies were assigned values of -1 and enabling policies +1. Publicly available data were used to conduct a cross-sectional study among all live births in the 50 U.S. states to people aged 15 to 44 between January 1, 2016, and December 31, 2018, to examine the association between the risk index and PRM, SMM, PTB, and low birthweight. We used linear regression with state scores and quartiles, adjusted for state-level proportions of White, Black, and Hispanic live births; percent living in rural areas; percent of population foreign born; Health Resources and Services Administration spending on maternal and child health; and the Opportunity Index, a composite measure of indicators of the economy, education, and community. RESULTS From 2016 to 2018, there were 11,530,785 births, 2,846 pregnancy-related deaths, and 154,384 cases of SMM. The Delphi panel resulted in a summed state measure of 106 laws in 8 categories that could affect reproductive autonomy. In adjusted analyses, states in the most enabling (most reproductive autonomy) quartile had a 44.7 per 10,000 higher rate of SMM compared with the most restrictive quartile. However, the most enabling quartile was associated with a 9.87 per 100,000 lower rate of PRM and 0.67 per 100 lower rate of PTB compared with the most restrictive quartile (least reproductive autonomy). CONCLUSIONS A composite policy index of reproductive autonomy was found to be associated with higher rates of SMM but lower rates of PRM and PTB. Further research is needed to understand how reproductive autonomy in the cumulative index may influence these and other maternal and birth outcomes.
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Affiliation(s)
- Andrew S Bossick
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington; Henry Ford Health, Detroit, Michigan.
| | - Ian Painter
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington; Washington State Department of Health, Olympia, Washington
| | - Emily C Williams
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington; U.S. Department of Veterans Affairs (VA), Health Services Research and Development (HSR&D), Center of Innovation for Veteran Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, Washington
| | - Jodie G Katon
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington; U.S. Department of Veterans Affairs (VA), Health Services Research and Development (HSR&D), Center of Innovation for Veteran Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, Washington
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Baum SE, Sierra G, Grossman D, Vizcarra E, Potter JE, White K. Comparing preference for and use of medication abortion in Texas after policy changes in 2014 and 2018. Contraception 2023; 119:109912. [PMID: 36473511 PMCID: PMC9985975 DOI: 10.1016/j.contraception.2022.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/14/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Assess preferences for and use of medication abortion in Texas after implementation of two policy changes: a 2013 state law restricting medication abortion and the FDA label change for mifepristone in 2016 nullifying some of this restriction. STUDY DESIGN We analyzed surveys conducted in 2014 and 2018 with abortion patients at 10 Texas abortion facilities. We calculated the percentage of all respondents with an initial preference for medication abortion by survey year, and the type of abortion obtained or planned to obtain among those who were at <10 weeks of gestation. We used multivariable-adjusted mixed-effects Poisson regression models to assess factors associated with medication abortion preference and actual/planned use. RESULTS Overall, 156 (41%) of 376 respondents in 2014 and 247 (55%) of 448 respondents in 2018 reported initial preference for medication abortion (Prevalence ratio [PR]: 1.28; 95% CI 1.03-1.59). Among those who were <10 weeks of gestation and initially preferred medication abortion, 39 of 124 (31%) obtained or were planning to obtain the method in 2014, compared with 188 of 223 (84%) in 2018 (PR: 2.65; 95% CI: 1.69-4.15). After multivariable adjustment, respondents who initially preferred medication abortion and were 7 to 9 weeks of gestation at the time of their ultrasonography (vs <7 weeks) were less likely to obtain or plan to obtain the method (PR: 0.69; 95% CI: 0.57-0.84). CONCLUSIONS Abortion patients were more likely to prefer and obtain or plan to obtain their preferred medication abortion after legal restrictions in Texas were nullified. IMPLICATIONS State policies can affect people's ability to obtain their preferred abortion method. Efforts to provide both abortion options whenever possible, and inform people where each can be obtained, remains an important component of person-centered care despite increasing state abortion restrictions and bans following the reversal of Roe v Wade.
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Affiliation(s)
- Sarah E Baum
- Texas Policy Evaluation Project, Population Resource Center, The University of Texas at Austin, Austin, TX, United States; Ibis Reproductive Health, Oakland, CA, United States.
| | - Gracia Sierra
- Texas Policy Evaluation Project, Population Resource Center, The University of Texas at Austin, Austin, TX, United States; Population Research Center, The University of Texas at Austin, Austin, TX, United States
| | - Daniel Grossman
- Texas Policy Evaluation Project, Population Resource Center, The University of Texas at Austin, Austin, TX, United States; Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, Oakland, CA, United States
| | - Elsa Vizcarra
- Texas Policy Evaluation Project, Population Resource Center, The University of Texas at Austin, Austin, TX, United States; Population Research Center, The University of Texas at Austin, Austin, TX, United States
| | - Joseph E Potter
- Texas Policy Evaluation Project, Population Resource Center, The University of Texas at Austin, Austin, TX, United States; Population Research Center, The University of Texas at Austin, Austin, TX, United States
| | - Kari White
- Texas Policy Evaluation Project, Population Resource Center, The University of Texas at Austin, Austin, TX, United States; Population Research Center, The University of Texas at Austin, Austin, TX, United States; Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, United States
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Jones RK, Jerman J. Population Group Abortion Rates and Lifetime Incidence of Abortion: United States, 2008-2014. Am J Public Health 2022; 112:1284-1296. [PMID: 35969818 PMCID: PMC9382183 DOI: 10.2105/ajph.2017.304042r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Why restricting access to abortion damages women's health. PLoS Med 2022; 19:e1004075. [PMID: 35881637 PMCID: PMC9321431 DOI: 10.1371/journal.pmed.1004075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Dr. Caitlin Moyer discusses the implications, for women globally, of restricting access to abortion care.
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Bossick AS, Brown J, Hanna A, Parrish C, Williams EC, Katon JG. Impact of State-Level Reproductive Health Legislation on Access to and Use of Reproductive Health Services and Reproductive Health Outcomes: A Systematic Scoping Review in the Affordable Care Act Era. Womens Health Issues 2020; 31:114-121. [PMID: 33303355 DOI: 10.1016/j.whi.2020.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 10/13/2020] [Accepted: 11/05/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION We systematically reviewed the literature to understand the associations between state-level reproductive health policies and reproductive health care outcomes and describe policy impacts on reproductive health outcomes among women aged 18 and older. We focused on research conducted after the implementation of the Patient Protection and Affordable Care Act to understand the influence of state-level policies in the context of existing federal policy. METHODS Standard search terms were used to search PubMed for studies published between March 10, 2010, and August 31, 2019. Studies were included that reflected original U.S.-based research testing associations between state-level policies (i.e., laws related to family planning, maternity care, and abortion) and reproductive health outcomes related to those services (e.g., prenatal care use) among adults. Reference lists of systematic reviews were searched to improve the identification of relevant studies. Studies were excluded if they were reviews, qualitative or mixed-methods studies, or descriptive studies, or if a state was not the unit of analysis. After dual review, agreement on inclusion of studies was 100%. RESULTS Search results returned 1,529 articles; 56 (3.59%) met the inclusion criteria for a full review based on title and abstract review. After dual independent review, eight were selected for inclusion. Two included all 50 states and Washington, DC; one included Oregon and Washington; and the remaining studies included single states (Texas, Arizona, Ohio, and Utah). One-half of the studies (n = 4) focused solely on restrictive abortion legislation. Restricting access to family planning and abortion services (e.g., mandatory waiting periods) were associated with negative outcomes (e.g., additional interventions for medication abortion). Expanding maternity care through Medicaid reform and autonomous midwifery laws were associated with positive outcomes (e.g., prenatal care use). CONCLUSIONS Our review identified eight studies that were largely focused on only one key aspect of reproductive health policy. Findings suggest that state-level legislation could have considerable impact on the reproductive health care that women have access to and receive, as well as the related outcomes. Research in this area remains limited. Rigorous evaluations of the relationship between the breadth of reproductive health policies and related health outcomes are needed, as is an exploration of barriers to the conduct of this type of research.
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Affiliation(s)
- Andrew S Bossick
- U.S. Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, Washington; Department of Health Services, University of Washington, Seattle, Washington.
| | - Jennifer Brown
- Department of Epidemiology, University of Washington, Seattle, Washington
| | - Ami Hanna
- Department of Health Services, University of Washington, Seattle, Washington
| | - Canada Parrish
- Department of Health Services, University of Washington, Seattle, Washington
| | - Emily C Williams
- U.S. Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, Washington; Department of Health Services, University of Washington, Seattle, Washington
| | - Jodie G Katon
- U.S. Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, Washington; Department of Health Services, University of Washington, Seattle, Washington
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Norris AH, Chakraborty P, Lang K, Hood RB, Hayford SR, Keder L, Bessett D, Smith MH, Hill BJ, Broscoe M, Norwood C, McGowan ML. Abortion Access in Ohio's Changing Legislative Context, 2010-2018. Am J Public Health 2020; 110:1228-1234. [PMID: 32437269 DOI: 10.2105/ajph.2020.305706] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To examine abortion utilization in Ohio from 2010 to 2018, a period when more than 15 abortion-related laws became effective.Methods. We evaluated changes in abortion rates and ratios examining gestation, geographic distribution, and abortion method in Ohio from 2010 to 2018. We used data from Ohio's Office of Vital Statistics, the Centers for Disease Control and Prevention's Abortion Surveillance Reports, the American Community Survey, and Ohio's Public Health Data Warehouse.Results. During 2010 through 2018, abortion rates declined similarly in Ohio, the Midwest, and the United States. In Ohio, the proportion of early first trimester abortions decreased; the proportion of abortions increased in nearly every later gestation category. Abortion ratios decreased sharply in most rural counties. When clinics closed, abortion ratios dropped in nearby counties.Conclusions. More Ohioans had abortions later in the first trimester, compared with national patterns, suggesting delays to care. Steeper decreases in abortion ratios in rural versus urban counties suggest geographic inequity in abortion access.Public Health Implications. Policies restricting abortion access in Ohio co-occur with delays to care and increasing geographic inequities. Restrictive policies do not improve reproductive health.
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Affiliation(s)
- Alison H Norris
- At the time of the study, Alison H. Norris, Payal Chakraborty, Kaiting Lang, Robert B. Hood, and Mikaela H. Smith were with the College of Public Health, Ohio State University, Columbus. Sarah R. Hayford was with the Department of Sociology, Ohio State University, Columbus. Lisa Keder was with the College of Medicine, Ohio State University, Columbus. Danielle Bessett and Molly Broscoe were with the Department of Sociology, University of Cincinnati, Cincinnati, OH. B. Jessie Hill was with the Case Western Reserve University School of Law, Cleveland, OH. Carolette Norwood was with the Department of Women's, Gender & Sexuality Studies, University of Cincinnati. Michelle L. McGowan was with Cincinnati Children's Hospital Medical Center Ethics Center, Cincinnati, OH
| | - Payal Chakraborty
- At the time of the study, Alison H. Norris, Payal Chakraborty, Kaiting Lang, Robert B. Hood, and Mikaela H. Smith were with the College of Public Health, Ohio State University, Columbus. Sarah R. Hayford was with the Department of Sociology, Ohio State University, Columbus. Lisa Keder was with the College of Medicine, Ohio State University, Columbus. Danielle Bessett and Molly Broscoe were with the Department of Sociology, University of Cincinnati, Cincinnati, OH. B. Jessie Hill was with the Case Western Reserve University School of Law, Cleveland, OH. Carolette Norwood was with the Department of Women's, Gender & Sexuality Studies, University of Cincinnati. Michelle L. McGowan was with Cincinnati Children's Hospital Medical Center Ethics Center, Cincinnati, OH
| | - Kaiting Lang
- At the time of the study, Alison H. Norris, Payal Chakraborty, Kaiting Lang, Robert B. Hood, and Mikaela H. Smith were with the College of Public Health, Ohio State University, Columbus. Sarah R. Hayford was with the Department of Sociology, Ohio State University, Columbus. Lisa Keder was with the College of Medicine, Ohio State University, Columbus. Danielle Bessett and Molly Broscoe were with the Department of Sociology, University of Cincinnati, Cincinnati, OH. B. Jessie Hill was with the Case Western Reserve University School of Law, Cleveland, OH. Carolette Norwood was with the Department of Women's, Gender & Sexuality Studies, University of Cincinnati. Michelle L. McGowan was with Cincinnati Children's Hospital Medical Center Ethics Center, Cincinnati, OH
| | - Robert B Hood
- At the time of the study, Alison H. Norris, Payal Chakraborty, Kaiting Lang, Robert B. Hood, and Mikaela H. Smith were with the College of Public Health, Ohio State University, Columbus. Sarah R. Hayford was with the Department of Sociology, Ohio State University, Columbus. Lisa Keder was with the College of Medicine, Ohio State University, Columbus. Danielle Bessett and Molly Broscoe were with the Department of Sociology, University of Cincinnati, Cincinnati, OH. B. Jessie Hill was with the Case Western Reserve University School of Law, Cleveland, OH. Carolette Norwood was with the Department of Women's, Gender & Sexuality Studies, University of Cincinnati. Michelle L. McGowan was with Cincinnati Children's Hospital Medical Center Ethics Center, Cincinnati, OH
| | - Sarah R Hayford
- At the time of the study, Alison H. Norris, Payal Chakraborty, Kaiting Lang, Robert B. Hood, and Mikaela H. Smith were with the College of Public Health, Ohio State University, Columbus. Sarah R. Hayford was with the Department of Sociology, Ohio State University, Columbus. Lisa Keder was with the College of Medicine, Ohio State University, Columbus. Danielle Bessett and Molly Broscoe were with the Department of Sociology, University of Cincinnati, Cincinnati, OH. B. Jessie Hill was with the Case Western Reserve University School of Law, Cleveland, OH. Carolette Norwood was with the Department of Women's, Gender & Sexuality Studies, University of Cincinnati. Michelle L. McGowan was with Cincinnati Children's Hospital Medical Center Ethics Center, Cincinnati, OH
| | - Lisa Keder
- At the time of the study, Alison H. Norris, Payal Chakraborty, Kaiting Lang, Robert B. Hood, and Mikaela H. Smith were with the College of Public Health, Ohio State University, Columbus. Sarah R. Hayford was with the Department of Sociology, Ohio State University, Columbus. Lisa Keder was with the College of Medicine, Ohio State University, Columbus. Danielle Bessett and Molly Broscoe were with the Department of Sociology, University of Cincinnati, Cincinnati, OH. B. Jessie Hill was with the Case Western Reserve University School of Law, Cleveland, OH. Carolette Norwood was with the Department of Women's, Gender & Sexuality Studies, University of Cincinnati. Michelle L. McGowan was with Cincinnati Children's Hospital Medical Center Ethics Center, Cincinnati, OH
| | - Danielle Bessett
- At the time of the study, Alison H. Norris, Payal Chakraborty, Kaiting Lang, Robert B. Hood, and Mikaela H. Smith were with the College of Public Health, Ohio State University, Columbus. Sarah R. Hayford was with the Department of Sociology, Ohio State University, Columbus. Lisa Keder was with the College of Medicine, Ohio State University, Columbus. Danielle Bessett and Molly Broscoe were with the Department of Sociology, University of Cincinnati, Cincinnati, OH. B. Jessie Hill was with the Case Western Reserve University School of Law, Cleveland, OH. Carolette Norwood was with the Department of Women's, Gender & Sexuality Studies, University of Cincinnati. Michelle L. McGowan was with Cincinnati Children's Hospital Medical Center Ethics Center, Cincinnati, OH
| | - Mikaela H Smith
- At the time of the study, Alison H. Norris, Payal Chakraborty, Kaiting Lang, Robert B. Hood, and Mikaela H. Smith were with the College of Public Health, Ohio State University, Columbus. Sarah R. Hayford was with the Department of Sociology, Ohio State University, Columbus. Lisa Keder was with the College of Medicine, Ohio State University, Columbus. Danielle Bessett and Molly Broscoe were with the Department of Sociology, University of Cincinnati, Cincinnati, OH. B. Jessie Hill was with the Case Western Reserve University School of Law, Cleveland, OH. Carolette Norwood was with the Department of Women's, Gender & Sexuality Studies, University of Cincinnati. Michelle L. McGowan was with Cincinnati Children's Hospital Medical Center Ethics Center, Cincinnati, OH
| | - B Jessie Hill
- At the time of the study, Alison H. Norris, Payal Chakraborty, Kaiting Lang, Robert B. Hood, and Mikaela H. Smith were with the College of Public Health, Ohio State University, Columbus. Sarah R. Hayford was with the Department of Sociology, Ohio State University, Columbus. Lisa Keder was with the College of Medicine, Ohio State University, Columbus. Danielle Bessett and Molly Broscoe were with the Department of Sociology, University of Cincinnati, Cincinnati, OH. B. Jessie Hill was with the Case Western Reserve University School of Law, Cleveland, OH. Carolette Norwood was with the Department of Women's, Gender & Sexuality Studies, University of Cincinnati. Michelle L. McGowan was with Cincinnati Children's Hospital Medical Center Ethics Center, Cincinnati, OH
| | - Molly Broscoe
- At the time of the study, Alison H. Norris, Payal Chakraborty, Kaiting Lang, Robert B. Hood, and Mikaela H. Smith were with the College of Public Health, Ohio State University, Columbus. Sarah R. Hayford was with the Department of Sociology, Ohio State University, Columbus. Lisa Keder was with the College of Medicine, Ohio State University, Columbus. Danielle Bessett and Molly Broscoe were with the Department of Sociology, University of Cincinnati, Cincinnati, OH. B. Jessie Hill was with the Case Western Reserve University School of Law, Cleveland, OH. Carolette Norwood was with the Department of Women's, Gender & Sexuality Studies, University of Cincinnati. Michelle L. McGowan was with Cincinnati Children's Hospital Medical Center Ethics Center, Cincinnati, OH
| | - Carolette Norwood
- At the time of the study, Alison H. Norris, Payal Chakraborty, Kaiting Lang, Robert B. Hood, and Mikaela H. Smith were with the College of Public Health, Ohio State University, Columbus. Sarah R. Hayford was with the Department of Sociology, Ohio State University, Columbus. Lisa Keder was with the College of Medicine, Ohio State University, Columbus. Danielle Bessett and Molly Broscoe were with the Department of Sociology, University of Cincinnati, Cincinnati, OH. B. Jessie Hill was with the Case Western Reserve University School of Law, Cleveland, OH. Carolette Norwood was with the Department of Women's, Gender & Sexuality Studies, University of Cincinnati. Michelle L. McGowan was with Cincinnati Children's Hospital Medical Center Ethics Center, Cincinnati, OH
| | - Michelle L McGowan
- At the time of the study, Alison H. Norris, Payal Chakraborty, Kaiting Lang, Robert B. Hood, and Mikaela H. Smith were with the College of Public Health, Ohio State University, Columbus. Sarah R. Hayford was with the Department of Sociology, Ohio State University, Columbus. Lisa Keder was with the College of Medicine, Ohio State University, Columbus. Danielle Bessett and Molly Broscoe were with the Department of Sociology, University of Cincinnati, Cincinnati, OH. B. Jessie Hill was with the Case Western Reserve University School of Law, Cleveland, OH. Carolette Norwood was with the Department of Women's, Gender & Sexuality Studies, University of Cincinnati. Michelle L. McGowan was with Cincinnati Children's Hospital Medical Center Ethics Center, Cincinnati, OH
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Barr-Walker J, Jayaweera RT, Ramirez AM, Gerdts C. Experiences of women who travel for abortion: A mixed methods systematic review. PLoS One 2019; 14:e0209991. [PMID: 30964860 PMCID: PMC6456165 DOI: 10.1371/journal.pone.0209991] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 12/16/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To systematically review the literature on women's experiences traveling for abortion and assess how this concept has been explored and operationalized, with a focus on travel distance, cost, delays, and other barriers to receiving services. BACKGROUND Increasing limitations on abortion providers and access to care have increased the necessity of travel for abortion services around the world. No systematic examination of women's experiences traveling for abortion has been conducted; this mixed-methods review provides a summary of the qualitative and quantitative literature on this topic. METHODS A systematic search was conducted using PubMed, Embase, Web of Science, Popline, and Google Scholar in July 2016 and updated in March 2017 (PROSPERO registration # CRD42016046007). We included original research studies that described women's experiences traveling for abortion. Two reviewers independently performed article screening, data extraction and determination of final inclusion for analysis. Critical appraisal was conducted using CASP, STROBE, and MMAT checklists. RESULTS We included 59 publications: 46 quantitative studies, 12 qualitative studies, and 1 mixed-methods study. Most studies were published in the last five years, relied on data from the US, and discussed travel as a secondary outcome of interest. In quantitative studies, travel was primarily conceptualized and measured as road or straight-line distance to abortion provider, though some studies also incorporated measures of burdens related to travel, such as financial cost, childcare needs, and unwanted disclosure of their abortion status to others. Qualitative studies explored regional disparities in access to abortion care, with a focus on the burdens related to travel, the impact of travel on abortion method choice, and women's reasons for travel. Studies generally were of high quality, though many studies lacked information on participant recruitment or consideration of potential biases. CONCLUSIONS Standardized measurements of travel, including burdens associated with travel and more nuanced considerations of travel costs, should be implemented in order to facilitate comparison across studies. More research is needed to explore and accurately capture different dimensions of the burden of travel for abortion services on women's lives.
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Affiliation(s)
- Jill Barr-Walker
- ZSFG Library, University of California, San Francisco, San Francisco, California, United States of America
- * E-mail:
| | - Ruvani T. Jayaweera
- Ibis Reproductive Health, Oakland, California, United States of America
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California, United States of America
| | - Ana Maria Ramirez
- Ibis Reproductive Health, Oakland, California, United States of America
| | - Caitlin Gerdts
- Ibis Reproductive Health, Oakland, California, United States of America
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Williams SG, Roberts S, Kerns JL. Effects of Legislation Regulating Abortion in Arizona. Womens Health Issues 2018; 28:297-300. [DOI: 10.1016/j.whi.2018.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 01/28/2018] [Accepted: 02/05/2018] [Indexed: 10/17/2022]
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Upadhyay UD, Johns NE, Cartwright AF, Franklin TE. Sociodemographic Characteristics of Women Able to Obtain Medication Abortion Before and After Ohio's Law Requiring Use of the Food and Drug Administration Protocol. Health Equity 2018; 2:122-130. [PMID: 30283858 PMCID: PMC6071907 DOI: 10.1089/heq.2018.0002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose: In 2011, a law went into effect in Ohio that regulates how abortion care providers can offer medication abortion to their patients. We sought to evaluate changes in sociodemographic characteristics of Ohio medication abortion patients before and after the implementation of this law. Methods: We used a retrospective cohort design, comparing characteristics of women obtaining a medication abortion at four abortion facilities before and after the law. We used chart data from January 2010 to January 2011 and February 2011 to October 2014. For any significant changes in sociodemographics found before and after the law, we used stratified cross-tabulations to disentangle whether they were likely related to the restricted gestational limit imposed by the law (lowered from 9 to 7 weeks gestation), or whether they were likely related to other burdens brought on by the law, such as increased costs and visits. Results: Women obtaining a medication abortion after the law were more likely to be older (p=0.01), have higher levels of education (p<0.001), be of white race (p<0.001), have private insurance (p=0.001), have no children (p=0.002), and reside in a higher income zip code (p=0.03). Both the reduced gestational limit and the increased costs and visits likely contributed to declines among black women and women with lower levels of education. The reduced gestational limit for medication abortion likely contributed to a decline among younger women and Medicaid recipient groups. The increased costs and visits imposed by the law likely contributed to the decline in medication abortion among women with no insurance and women with children. Conclusion: The lower gestational limit, higher cost, and time and travel burdens exacted by Ohio's medication abortion law were associated with disproportionate reductions in medication abortion among the most disadvantaged groups. The law was associated with reduced access among women who were younger, of black race, less educated, and in lower socioeconomic groups.
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Affiliation(s)
- Ushma D. Upadhyay
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, Oakland, California
| | - Nicole E. Johns
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, Oakland, California
| | - Alice F. Cartwright
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, Oakland, California
| | - Tanya E. Franklin
- Department of Obstetrics, Gynecology, and Women's Health, University of Louisville School of Medicine, Louisville, Kentucky
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Abstract
PURPOSE OF REVIEW To review the status of antiabortion restrictions enacted over the last 5 years in the United States and their impact on abortion services. RECENT FINDINGS In recent years, there has been an alarming rise in the number of antiabortion laws enacted across the United States. In total, various states in the union enacted 334 abortion restrictions from 2011 to July 2016, accounting for 30% of all abortion restrictions since the legalization of abortion in 1973. Data confirm, however, that more liberal abortion laws do not increase the number of abortions, but instead greatly decrease the number of abortion-related deaths. Several countries including Romania, South Africa and Nepal have seen dramatic decreases in maternal mortality after liberalization of abortion laws, without an increase in the total number of abortions. In the United States, abortions are incredibly safe with very low rates of complications and a mortality rate of 0.7 per 100 000 women. With increasing abortion restrictions, maternal mortality in the United States can be expected to rise over the coming years, as has been observed in Texas recently. SUMMARY Liberalization of abortion laws saves women's lives. The rising number of antiabortion restrictions will ultimately harm women and their families.
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Jones RK, Jerman J. Population Group Abortion Rates and Lifetime Incidence of Abortion: United States, 2008-2014. Am J Public Health 2017; 107:1904-1909. [PMID: 29048970 DOI: 10.2105/ajph.2017.304042] [Citation(s) in RCA: 147] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess the prevalence of abortion among population groups and changes in rates between 2008 and 2014. METHODS We used secondary data from the Abortion Patient Survey, the American Community Survey, and the National Survey of Family Growth to estimate abortion rates. We used information from the Abortion Patient Survey to estimate the lifetime incidence of abortion. RESULTS Between 2008 and 2014, the abortion rate declined 25%, from 19.4 to 14.6 per 1000 women aged 15 to 44 years. The abortion rate for adolescents aged 15 to 19 years declined 46%, the largest of any group. Abortion rates declined for all racial and ethnic groups but were larger for non-White women than for non-Hispanic White women. Although the abortion rate decreased 26% for women with incomes less than 100% of the federal poverty level, this population had the highest abortion rate of all the groups examined: 36.6. If the 2014 age-specific abortion rates prevail, 24% of women aged 15 to 44 years in that year will have an abortion by age 45 years. CONCLUSIONS The decline in abortion was not uniform across all population groups.
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Affiliation(s)
- Rachel K Jones
- Rachel K. Jones and Jenna Jerman are with the Research Division of the Guttmacher Institute, New York, NY
| | - Jenna Jerman
- Rachel K. Jones and Jenna Jerman are with the Research Division of the Guttmacher Institute, New York, NY
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15
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Situating stigma in stratified reproduction: Abortion stigma and miscarriage stigma as barriers to reproductive healthcare. SEXUAL & REPRODUCTIVE HEALTHCARE 2016; 10:62-69. [PMID: 27938875 DOI: 10.1016/j.srhc.2016.10.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 10/28/2016] [Accepted: 10/31/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To examine whether race and reported history of abortion are associated with abortion stigma and miscarriage stigma, both independently and comparatively. STUDY DESIGN Self-administered surveys with 306 new mothers in Boston and Cincinnati, United States. MAIN OUTCOME MEASURES Abortion stigma perception (ASP); miscarriage stigma perception (MSP); and comparative stigma perception (CSP: abortion stigma perception net of miscarriage stigma perception). RESULTS Regardless of whether or not they reported having an abortion, white women perceived abortion (ASP) to be more stigmatizing than Black and Latina women. Perceptions of miscarriage stigma (MSP), on the other hand, were dependent on reporting an abortion. Among those who reported an abortion, Black women perceived more stigma from miscarriage than white women, but these responses were flipped for women who did not report abortion. Reporting abortion also influenced our comparative measure (CSP). Among those who did report an abortion, white women perceived more stigma from abortion than miscarriage, while Black and Latina women perceived more stigma from miscarriage than abortion. CONCLUSIONS By measuring abortion stigma in comparison to miscarriage stigma, we can reach a more nuanced understanding of how perceptions of reproductive stigmas are stratified by race and reported reproductive history. Clinicians should be aware that reproductive stigmas do not similarly affect all groups. Stigma from specific reproductive outcomes is more or less salient dependent upon a woman's social position and lived experience.
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Women's Experience Obtaining Abortion Care in Texas after Implementation of Restrictive Abortion Laws: A Qualitative Study. PLoS One 2016; 11:e0165048. [PMID: 27783708 DOI: 10.1371/journal.pone.0165048] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 10/05/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In November 2013, Texas implemented three abortion restrictions included in House Bill 2 (HB 2). Within six months, the number of facilities providing abortion decreased by almost half, and the remaining facilities were concentrated in large urban centers. The number of medication abortions decreased by 70% compared to the same period one year prior due to restrictions on this method imposed by HB 2. The purpose of this study was to explore qualitatively the experiences of women who were most affected by the law: those who had to travel farther to reach a facility and those desiring medication abortion. METHODS In August and September 2014, we conducted 20 in-depth interviews with women recruited from ten abortion clinics across Texas. The purposive sample included women who obtained or strongly preferred medication abortion or traveled ≥50 miles one way to the clinic. The interview guide focused on women's experiences with obtaining services following implementation of HB 2, and a thematic analysis was performed. RESULTS Women faced informational, cost and logistical barriers seeking abortion services, and these obstacles were often compounded by poverty. Two women found the process of finding or getting to a clinic so onerous that they considered not having the procedure, although they ultimately had an abortion; another woman decided to continue her pregnancy, in part because of challenges in getting to the clinic. For two women, arranging travel required disclosure to more people than desired. Women who strongly preferred medication abortion were frustrated by the difficulty or inability to obtain their desired method, especially among those who were near or just beyond the gestational age limit. The restricted eligibility criteria for medication abortion and difficulty finding clinics offering the method created substantial access barriers. CONCLUSIONS Medication abortion restrictions and clinic closures following HB 2 created substantial barriers for women seeking abortion in Texas.
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Sheldon WR, Winikoff B. Mifepristone label laws and trends in use: recent experiences in four US states. Contraception 2015; 92:182-5. [PMID: 26116033 DOI: 10.1016/j.contraception.2015.06.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 06/18/2015] [Accepted: 06/19/2015] [Indexed: 10/23/2022]
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