Abstract
We examine characteristics and experiences of women who considered, but did not have, an abortion for this pregnancy. Participants were recruited at prenatal care clinics in Louisiana and Maryland for a mixed-methods study (N = 589). On self-administered surveys and structured interviews, participants were asked if they had considered abortion for this pregnancy and, if so, reasons they did not obtain one. A subset (n = 83), including participants who considered abortion for this pregnancy, completed in-depth phone interviews. Multivariable logistic regression analyses examined characteristics associated with having considered abortion and experiencing a policy-related barrier to having an abortion; analyses focused on economic insecurity and of mental health/substance use as main predictors of interest. Louisiana interviews (n = 43) were analyzed using modified grounded theory to understand concrete experiences of policy-related factors. In regression analyses, women who reported greater economic insecurity (aOR 1.21 [95% CI 1.17, 1.26]) and more mental health diagnoses/substance use (aOR 1.29 [1.16, 1.45] had higher odds of having considered abortion. Those who reported greater economic insecurity (aOR 1.50 [1.09, 2.08]) and more mental health diagnoses/substance use (aOR 1.45 [95% CI 1.03, 2.05] had higher odds of reporting policy-related barriers. Interviewees who considered abortion and were subject to multiple restrictions on abortion identified material and instrumental impacts of policies that, collectively, contributed to them not having an abortion. Many described simultaneously navigating economic insecurity, mental health disorders, substance use, and interpersonal opposition to abortion from family and the man involved in the pregnancy. Current restrictive abortion policies appear to have more of an impact on women who report greater economic insecurity and more mental health diagnoses/substance use. These policies work in concert with each other, with people’s individual complex situations–including economic insecurity, mental health, and substance use–and with anti-abortion attitudes of other people to make abortion care impossible for some pregnant women to access.
Highlights
In the first half of 2019, seven states have passed laws that ban abortions after 6-weeks of pregnancy, before many women know they are pregnant [1].These bans are a direct legal challenge to Roe v
Based on previous research that finds economic insecurity, mental health, and substance use contribute to delay in discovering pregnancy [17, 18] and in presenting for abortion care [19], we examine these factors in particular
Reporting having considered abortion in the iPad survey was not associated with completing the in-clinic interview
Summary
In the first half of 2019, seven states have passed laws that ban abortions after 6-weeks of pregnancy, before many women know they are pregnant [1].These bans are a direct legal challenge to Roe v. Wade[2, 3] the U.S Supreme Court decision that legalized abortion throughout the U.S in 1973 [4]. What these bans purport to accomplish–making abortion impossible to obtain in that state–is already happening in some states for some women [5, 6]. More states have multiple simultaneous restrictive policies in place [15]; previous research that examined impacts of restrictive abortion policies one-by-one may be less relevant for women’s actual experiences in current policy environments. Two studies examined impacts of Texas’s HB2 law that had two restrictive policies go into effect at the same time, attributing a 13% reduction in the abortion rate due to the two policies, and found that the few women who did not obtain abortions described insufficient information about alternative open abortion facilities and lack of money and time as contributing to them continuing their pregnancies after the clinics closed [7, 16]
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