Abstract
Most research about experiences considering and seeking abortion comes from women presenting at abortion clinics. This study examines experiences among women presenting at prenatal care. Five hundred eighty-nine women were recruited at their first prenatal visit in Southern Louisiana and Baltimore, Maryland. Participants completed self-administered iPad surveys and in-clinic structured interviews. Participants were asked if they had considered abortion for this pregnancy and, if so, reasons they did not obtain one. Twenty-eight percent of Louisiana and 34% of Maryland participants had considered abortion. Ten percent in Louisiana and 13% in Maryland had called an abortion clinic; 2% in Louisiana and 3% in Maryland had visited an abortion clinic. The most common reason for not having an abortion related to women’s own decision-making, i.e. their personal preferences. Policy-related reasons were less common; but more participants who had considered abortion in Louisiana than Maryland reported a policy-related reason (primarily lack of funding for the abortion) as a reason (22% Louisiana, 2% Maryland, p < 0.001). Recruiting in prenatal care is a feasible way to find women who considered, but did not obtain, an abortion for their current pregnancy. Women’s own preferences were the primary reason for not obtaining an abortion across settings, but more in Louisiana than Maryland faced policy-related barriers to abortion.
Highlights
Through the 2000s, research about state-level abortion restrictions in the USA primarily used vital statistics data to estimate changes in the abortion rate, delays in obtaining abortion, and changes in the proportion of women who travel out of state to obtain an abortion that were associated with state-level abortion restrictions (Colman & Joyce, 2009; Joyce, Henshaw, & Skatrud, 1997)
This research demonstrated that about one-fourth of women who would have had Medicaidfunded abortions instead give birth when this funding is unavailable (Henshaw, Joyce, Dennis, Finer, & Blanchard, 2009); that parental involvement laws are associated with an increased number of minors traveling out of state for abortion, but do not necessarily impact pregnancy or abortion rates (Dennis, Henshaw, Joyce, Finer, & Blanchard, 2009); and that while waiting periods that do not require an in-person visit have little impact, waiting periods that include a two-visit requirement are associated with a decreased abortion rate, increased travel out of state, and an increased rate of second trimester abortions (Joyce, Henshaw, Dennis, Finer, & Blanchard, 2009)
This study found that having considered abortion is not uncommon among a sample of primarily low-income women entering prenatal care in both Louisiana and Maryland, and that some women who experienced policy-related barriers to obtaining an abortion had not visited an abortion clinic prior to entering prenatal care. This indicates that lowincome women in prenatal care are willing to report and discuss their experiences considering and seeking abortion with researchers and, that recruiting in prenatal care is a feasible approach to explore and examine experiences of pregnant women who consider an abortion, but may never present for care at an abortion clinic
Summary
Through the 2000s, research about state-level abortion restrictions in the USA primarily used vital statistics data to estimate changes in the abortion rate, delays in obtaining abortion, and changes in the proportion of women who travel out of state to obtain an abortion that were associated with state-level abortion restrictions (Colman & Joyce, 2009; Joyce, Henshaw, & Skatrud, 1997). Sex Res Soc Policy (2019) 16:476–487 begun to complement existing research methods with newer research approaches, such as abortion-clinic-based medical chart reviews and surveys of women who present for an abortion (Roberts, Turok, Belusa, Combellick, & Upadhyay, 2016; Upadhyay et al, 2017). Research using these newer methods has found, for example, that laws passed in the name of patient safety—such as requiring medication abortion to be provided according to the original FDA protocol rather than current evidence-based protocols—resulted in a greater need for medical intervention and more side effects (Upadhyay et al, 2016). This research has found that laws such as 72-h waiting periods and mandatory ultrasound viewing that seek to dissuade women from having abortions do not typically affect women’s decisionmaking, but can lead to delays and increased financial and emotional costs (Roberts et al, 2016; Upadhyay et al, 2017)
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