Abstract
BackgroundPublic health agencies in the United States have engaged in abortion-related activities for nearly 50 years. Prior research indicates that, while most state health departments engage in some abortion-related work, their efforts reflect what is required by law rather than the breadth of core public health activities. In contrast, local health departments appear to engage in abortion-related activities less often but, when they do, initiate a broader range of activities.MethodsThis study aimed to: 1) describe the abortion-related activities undertaken by maternal and child health (MCH) and family planning professionals in state and local health departments; 2) understand how health departments approach their programmatic work on abortion, and 3) examine the facilitators and barriers to whether and how abortion work is implemented. Between November 2017 and June 2018, we conducted key informant interviews with 29 professionals working in 22 state and local health departments across the U.S. Interview data were thematically coded and analyzed using an iterative approach.ResultsMCH and family planning professionals described a range of abortion-related activities undertaken within their health departments. We identified three approaches to this work: those mandated strictly by law or policy; those initiated when mandated by law but informed by public health principles (e.g., scientific accuracy, expert engagement, lack of bias, promoting access to care) in implementation; and those initiated by professionals within the department to meet identified needs. More state health departments engaged in activities when mandated, and more local health departments initiated activities based on identified needs. Key barriers and facilitators included political climate, funding opportunities and restrictions, and departmental leadership.ConclusionsAlthough state health departments are tasked with implementing legally-required abortion-related activities, some agencies bring public health principles to their mandated work. Efforts are needed to engage public health professionals in developing and implementing best practices around engaging in abortion-related activities.
Highlights
Public health agencies in the United States have engaged in abortion-related activities for nearly 50 years
We systematically investigated the public-facing websites of state and local health departments to describe their activities related to abortion [11]
We found that most state health departments engage in some abortionrelated activities; these largely reflect legal requirements rather than the range of core public health activities outlined by the Essential Public Health Services (EPHS) framework
Summary
Public health agencies in the United States have engaged in abortion-related activities for nearly 50 years. Health departments and abortion The earliest governmental public health efforts related to abortion followed soon after its legalization and involved established public health tasks, including data surveillance and clinical quality improvement [6, 7]. In the late 1960s, the federal Centers for Disease Control and Prevention (CDC) established the national abortion surveillance system, based on reporting by and collaborations with state health departments. These data have been used to document the number and characteristics of women having legal abortions, as well as the safety of different procedures and care settings [8]. In 2016, 47 state health departments reported annual abortion data to the CDC’s surveillance system [10], and most states report detailed abortion data on their departmental websites that are available to the public [11, 12]
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