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Lands M, Dyer RL, Seymour JW. Sampling strategies among studies of barriers to abortion in the United States: A scoping review of abortion access research. Contraception 2024; 131:110342. [PMID: 38012964 DOI: 10.1016/j.contraception.2023.110342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVES Understanding barriers to abortion care is particularly important post-Dobbs. However, many abortion access studies recruit from abortion-providing facilities, which overlook individuals who do not present for clinic-based care. To our knowledge, no studies have reviewed research recruitment strategies in the literature or considered how they might affect our knowledge of abortion barriers. We aimed to identify populations included and sampling methods used in studies of abortion barriers in the United States. STUDY DESIGN We used a scoping review protocol to search five databases for articles examining US-based individuals' experiences accessing abortion. We included English-language articles published between January 2011 and February 2022. For included studies, we identified the sampling strategy and population recruited. RESULTS Our search produced 2763 articles, of which 71 met inclusion criteria. Half of the included papers recruited participants at abortion-providing facilities (n = 35), while the remainder recruited from online sources (n = 14), other health clinics (n = 10), professional organizations (n = 8), abortion funds (n = 2), community organizations (n = 2), key informants (n = 2), and an abortion storytelling project (n = 1). Most articles (n = 61) reported information from people discussing their own abortions; the rest asked nonabortion seekers (e.g., physicians, genetic counselors, attorneys) about barriers to care. CONCLUSIONS Studies of abortion barriers enroll participants from a range of venues, but the majority recruit people who obtained abortions, and half recruit from abortion clinics. IMPLICATIONS As abortion access becomes constrained and criminalized in the post-Roe context, our findings indicate how investigators might recruit study participants from a variety of settings to fully understand the abortion seeking experience.
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Affiliation(s)
- Madison Lands
- University of Wisconsin Collaborative for Reproductive Equity, Madison, WI, United States.
| | - Rachel L Dyer
- University of Wisconsin Collaborative for Reproductive Equity, Madison, WI, United States; University of Wisconsin Department of Counseling Psychology, Madison, WI, United States
| | - Jane W Seymour
- University of Wisconsin Collaborative for Reproductive Equity, Madison, WI, United States
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Fledderjohann J, Patterson S, Owino M. Food Insecurity: A Barrier to Reproductive Justice Globally. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2023; 35:296-311. [PMID: 38595861 PMCID: PMC10903663 DOI: 10.1080/19317611.2023.2201841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 04/04/2023] [Accepted: 04/07/2023] [Indexed: 04/11/2024]
Abstract
Objective: Reproductive Justice identifies three core reproductive rights for all people: (1) the right to not have a child; (2) the right to have a child; and (3) the right to parent children in safe and healthy environments. We aim to illustrate that food insecurity infringes upon on all three of these rights and so is a pressing issue for reproductive justice and for sexual and reproductive health more broadly. Methods: Using a phenomenological approach, we outline potential pathways between food insecurity and reproductive justice. Results: There are numerous potential pathways between food insecurity and reproductive justice, including entry into sexual relationships for material support, links to sexually transmitted infections and infertility, structural violence, prioritization and spending tradeoffs between food and other basic necessities, biological impacts of malnutrition, restricted reproductive choices, population control measures, and social stigma and exclusion. Marginalized people are disproportionately impacted by food insecurity and its consequences, with implications for sexual health and pleasure and for reproductive justice. Conclusions:Meaningful and equitable collaboration between people with lived experience of food insecurity, human rights and reproductive justice activists, and academics is critical to sensitively contextualize this work and mobilize broader social change.
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Affiliation(s)
| | - Sophie Patterson
- Faculty of Health and Medicine, Lancaster University, Bailrigg Campus, Lancaster, UK
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Maureen Owino
- Faculty of Environmental Studies and Urban Health, York University, Toronto, Canada
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3
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Ehrenreich K, Kimport K. Prenatal Care as a Gateway to Other Health Care: A Qualitative Study. Womens Health Issues 2022; 32:602-606. [DOI: 10.1016/j.whi.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 06/28/2022] [Accepted: 08/16/2022] [Indexed: 12/05/2022]
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Ogbu-Nwobodo L, Shim RS, Vinson SY, Fitelson EM, Biggs MA, McLemore MR, Thomas M, Godzich M, Mangurian C. Mental Health Implications of Abortion Restrictions for Historically Marginalized Populations. N Engl J Med 2022; 387:1613-1617. [PMID: 36300980 DOI: 10.1056/nejmms2211124] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Lucy Ogbu-Nwobodo
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
| | - Ruth S Shim
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
| | - Sarah Y Vinson
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
| | - Elizabeth M Fitelson
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
| | - M Antonia Biggs
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
| | - Monica R McLemore
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
| | - Marilyn Thomas
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
| | - Micaela Godzich
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
| | - Christina Mangurian
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
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Mifepristone: A Safe Method of Medical Abortion and Self-Managed Medical Abortion in the Post-Roe Era. Am J Ther 2022; 29:e534-e543. [PMID: 35994387 DOI: 10.1097/mjt.0000000000001559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The U.S. Supreme Court's Dobbs v. Jackson Women's Health Organization decision on June 24, 2022 effectively overturned federal constitutional protections for abortion that have existed since 1973 and returned jurisdiction to the states. Several states implemented abortion bans, some of which banned abortion after 6 weeks and others that permit abortion under limited exceptions, such as if the health or the life of the woman is in danger. Other states introduced bills that define life as beginning at fertilization. As a result of these new and proposed laws, the future availability of mifepristone, one of two drugs used for medical abortion in the United States, has become the topic of intense debate and speculation. AREAS OF UNCERTAINTY Although its safety and effectiveness has been confirmed by many studies, the use of mifepristone has been politicized regularly since its approval. Areas of future study include mifepristone for induction termination and fetal demise in the third trimester and the management of leiomyoma. DATA SOURCES PubMed, Society of Family Planning, American College of Obstetrician and Gynecologists, the World Health Organization. THERAPEUTIC ADVANCES The use of no-touch medical abortion, which entails providing a medical abortion via a telehealth platform without a screening ultrasound or bloodwork, expanded during the COVID-19 pandemic, and studies have confirmed its safety. With the Dobbs decision, legal abortion will be less accessible and, consequently, self-managed abortion with mifepristone and misoprostol will become more prevalent. CONCLUSIONS Mifepristone and misoprostol are extremely safe medications with many applications. In the current changing political climate, physicians and pregnancy-capable individuals must have access to these medications.
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Ralph L, Ehrenreich K, Kaller S, Biggs MA. A cross-sectional study examining consideration of self-managed abortion among people seeking facility-based care in the United States. Reprod Health 2022; 19:176. [PMID: 35962384 PMCID: PMC9375262 DOI: 10.1186/s12978-022-01486-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/22/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction With increasing restrictions on abortion across the United States, we sought to understand whether people seeking abortion would consider ending their pregnancy on their own if unable to access a facility-based abortion. Methods From January to June 2019, we surveyed patients seeking abortion at 4 facilities in 3 US states. We explored consideration of self-managed abortion (SMA) using responses to the question: “Would you consider ending this pregnancy on your own if you are unable to obtain care at a health care facility?” We used multivariable Poisson regression to assess associations between individual sociodemographic, pregnancy and care-seeking characteristics and prevalence of considering SMA. In bivariate Poisson models, we also explored whether consideration of SMA differed by specific obstacles to abortion care. Results One-third (34%) of 741 participants indicated they would definitely or probably consider ending the pregnancy on their own if unable to obtain care at a facility. Consideration of SMA was higher among those who reported no health insurance (adjusted prevalence ratio [aPR] = 1.66; 95% Confidence Interval [CI] 1.12–2.44), described the pregnancy as unintended (aPR = 1.53; 95% CI 1.08–2.16), were seeking abortion due to concerns about their own physical or mental health (aPR = 1.50, 95% CI 1.02, 2.20), or experienced obstacles that delayed their abortion care seeking (aPR = 2.26, 95% CI 1.49, 3.40). Compared to those who would not consider SMA, participants who would consider SMA expressed higher difficulty finding an abortion facility (35 vs. 27%, p = 0.019), figuring out how to get to the clinic (29 vs 21%, p = 0.021) and needing multiple clinic visits (23 vs 17%, p = 0.044). Conclusions. One in three people seeking facility-based abortion would consider SMA if unable to obtain abortion care at a facility. As abortion access becomes increasingly restricted in the US, SMA may become more common. Future research should continue to monitor people’s consideration and use of SMA and ensure that they have access to safe and effective methods.
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Affiliation(s)
- 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, 1330 Broadway Suite 1100, Oakland, CA, 94612, USA.
| | - Katherine Ehrenreich
- 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, 1330 Broadway Suite 1100, 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, 1330 Broadway Suite 1100, Oakland, CA, 94612, USA
| | - 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, 1330 Broadway Suite 1100, Oakland, CA, 94612, USA
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Maralit AM. Beyond the bump: ethical and legal considerations for psychologists providing services to pregnant individuals who use substances. ETHICS & BEHAVIOR 2022. [DOI: 10.1080/10508422.2022.2093202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Anna M. Maralit
- Department of Psychological Sciences, University of Missouri, Columbia, MO
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8
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Upadhyay UD, Ahlbach C, Kaller S, Cook C, Muñoz I. Trends In Self-Pay Charges And Insurance Acceptance For Abortion In The United States, 2017-20. Health Aff (Millwood) 2022; 41:507-515. [PMID: 35377750 DOI: 10.1377/hlthaff.2021.01528] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Hyde Amendment prevents federal funds, including Medicaid, from covering abortion care, and many states have legal restrictions that prevent private insurance plans from covering abortion. As a result, most people pay for abortion out of pocket. We examined patient self-pay charges for three abortion types (medication abortion, first-trimester procedural abortion, and second-trimester abortion), as well as facilities' acceptance of health insurance, during the period 2017-20. We found that during this time, median patient charges increased for medication abortion (from $495 to $560) and first-trimester procedural abortion (from $475 to $575) but not second-trimester abortion (from $935 to $895). The proportion of facilities that accept insurance decreased over time (from 89 percent to 80 percent). We noted substantial regional variation, with the South having lower costs and lower insurance acceptance. Charges for first-trimester procedural abortions are increasing, and acceptance of health insurance is declining. According to the Federal Reserve, one-quarter of Americans could not pay for a $400 emergency expense solely with the money in their bank accounts-an amount lower than any abortion cost in 2020. Lifting Hyde restrictions and requiring public and private health insurance to cover this essential, time-sensitive health service without copays or deductibles would greatly reduce the financial burden of abortion.
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Affiliation(s)
- Ushma D Upadhyay
- Ushma D. Upadhyay , University of California San Francisco (UCSF), San Francisco, California
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Toscano M, Wood J, Spielman S, Ferri R, Whaley N, Seligman NS. Prenatal care utilization in pregnant women who consider but do not have abortions. BMC Pregnancy Childbirth 2022; 22:53. [PMID: 35062913 PMCID: PMC8780296 DOI: 10.1186/s12884-021-04343-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 12/16/2021] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Over half of all pregnancies in the United States are unintended, and 18% result in termination of pregnancy (TOP). Some women seek TOP, but ultimately continue their pregnancy. Data are limited about their utilization of prenatal care and their perinatal outcomes. Our primary outcome was to investigate differences in guideline-based prenatal care utilization in women who consider but do not have an abortion.
Methods
Retrospective cohort study of patients having obstetrical dating ultrasound (US) from 2011–2018 at a single academic medical center that offers TOP. Contemplators completed US with intention of TOP but instead continued the pregnancy to live birth. A 2:1 group of non-contemplators completed US and continued to live birth. A prenatal care utilization scoring system was used to compare groups. Secondary outcomes investigated differences in adverse pregnancy outcomes and postpartum care.
Results
There were 94 contemplators and 183 non-contemplators. Inadequate prenatal care utilization initially was more common in contemplators than non-contemplators (62.8% vs 85.8%, p < 0.01) but was not significant after adjustment (aOR 1.0, 95% CI 0.40 – 2.56). There were no differences in adverse obstetric or neonatal outcomes. Contemplators were significantly more likely to have a postpartum contraceptive method (PPCM) upon hospital discharge (aOR 4.8, 95% CI 1.16 – 20.0) and significantly more likely to use a highly-effective PPCM (aOR 6.4, 95% CI 2.34 – 17.4).
Conclusions
Reversal of intention for TOP is not associated with differences in prenatal care utilization, but is associated with increased uptake of postpartum contraceptive method.
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Tebb KP, Brindis CD. Understanding the Psychological Impacts of Teenage Pregnancy through a Socio-ecological Framework and Life Course Approach. Semin Reprod Med 2022; 40:107-115. [PMID: 34991169 DOI: 10.1055/s-0041-1741518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The relationship between mental health and teenage pregnancy is complex. Mental health can be both an antecedent and contributing factor to teenage pregnancy and a concurrent factor wherein pregnancy itself can contribute to depression. Expectant and parenting teens (EPT) are faced with the simultaneous challenges of pregnancy and parenting while navigating the developmental tasks of adolescence which increases their risk for mental health problems. In addition, adolescents growing up in stressful community or home situations where their parents experienced depression, further places them and their children at greater risk of repeated patterns over time. However, adverse mental health outcomes are not inevitable. The socio-ecological model combined with a life course perspective provides a framework for understanding the complexity of risk and protective factors at multiple levels that influence knowledge, attitudes, behaviors, and other health outcomes later in life and across generations. This approach has important implications for reducing adolescents' risk of an unintended/mistimed pregnancy and improving mental health and other outcomes for EPT. This paper describes the prevalence of mental health problems in EPT and using a socio-ecological framework and life course perspective explains variations in mental health outcome among EPT. Implications for interventions and innovative approaches are also discussed.
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Affiliation(s)
- Kathleen P Tebb
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of California, California, San Francisco
| | - Claire D Brindis
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, Adolescent and Young Adult Health National Resource Center, University of California, California, San Francisco.,The Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, University of California, California, San Francisco
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Real-Time Effects of Payer Restrictions on Reproductive Healthcare: A Qualitative Analysis of Cost-Related Barriers and Their Consequences among U.S. Abortion Seekers on Reddit. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179013. [PMID: 34501602 PMCID: PMC8430941 DOI: 10.3390/ijerph18179013] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/20/2021] [Accepted: 08/22/2021] [Indexed: 01/07/2023]
Abstract
Objective: The Hyde Amendment and related policies limit or prohibit Medicaid coverage of abortion services in the United States. Most research on cost-related abortion barriers relies on clinic-based samples, but people who desire abortions may never make it to a healthcare center. To examine a novel, pre-abortion population, we analyzed a unique qualitative dataset of posts from Reddit, a widely used social media platform increasingly leveraged by researchers, to assess financial obstacles among anonymous posters considering abortion. Methods: In February 2020, we used Python to web-scrape the 250 most recent posts that mentioned abortion, removing all identifying information and usernames. After transferring all posts into NVivo, a qualitative software package, the team identified all datapoints related to cost. Three qualitatively trained evaluators established and applied codes, reaching saturation after 194 posts. The research team used a descriptive qualitative approach, using both inductive and deductive elements, to identify and analyze themes related to financial barriers. Results: We documented multiple cost-related deterrents, including lack of funds for both the procedure and attendant travel costs, inability to afford desired abortion modality (i.e., medication or surgical), and for some, consideration of self-managed abortion options due to cost barriers. Conclusions: Findings from this study underscore the centrality of cost barriers and third-party payer restrictions to stymying reproductive health access in the United States. Results may contribute to the growing evidence base and building political momentum focused on repealing the Hyde Amendment.
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Upadhyay UD, McCook AA, Bennett AH, Cartwright AF, Roberts SCM. State abortion policies and Medicaid coverage of abortion are associated with pregnancy outcomes among individuals seeking abortion recruited using Google Ads: A national cohort study. Soc Sci Med 2021; 274:113747. [PMID: 33642070 DOI: 10.1016/j.socscimed.2021.113747] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/22/2020] [Accepted: 02/03/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE A major challenge to understanding barriers to abortion is that those individuals most affected may never reach an abortion provider, making the full impact of restrictive policies difficult to measure. The Google Ads Abortion Access Study used a novel method to recruit individuals much earlier in the abortion-seeking process. We aimed to understand how state-level abortion policies and Medicaid coverage of abortion influence individuals' ability to obtain wanted abortions. METHODS We employed a stratified sampling design to recruit a national cohort from all 50 states searching Google for abortion care. Participants completed online baseline and 4-week follow-up surveys. The primary independent variables were: 1) state policy environment and 2) state coverage of abortion for people with Medicaid. We developed multivariable multinomial mixed effects models to estimate the associations between each state-level independent variable and pregnancy outcome. RESULTS Of the 874 participants with follow-up data, 48% had had an abortion, 32% were still seeking an abortion, and 20% were planning to continue their pregnancies at 4 weeks follow-up. Individuals in restricted access states had significantly higher odds of planning to continue the pregnancy at follow-up than participants in protected access states (aOR = 1.70, 95% CI = 1.08, 2.70). Individuals in states that do not provide coverage of abortion for people with Medicaid had significantly higher odds of still seeking an abortion at follow-up (aOR = 1.80, 95% CI = 1.24, 2.60). Individuals living in states without Medicaid coverage were significantly more likely to report that having to gather money to pay for travel expenses or for the abortion was a barrier to care. CONCLUSIONS Restrictive state-level abortion policies are associated with not having an abortion at all and lack of coverage for abortion is associated with prolonged abortion seeking. Medicaid coverage of abortion appears critical to ensuring that all people who want abortions can obtain them.
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Affiliation(s)
- Ushma D Upadhyay
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, USA.
| | - Ashley A McCook
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, USA
| | - Ariana H Bennett
- School of Public Health, University of California, Berkeley, USA
| | - Alice F Cartwright
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA; Carolina Population Center, University of North Carolina at Chapel Hill, USA
| | - Sarah C M Roberts
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, USA
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