Multinational physician perspectives on abortion care in the context of changing legislation

BackgroundSafe, accessible, and inclusive abortion care and pregnancy options counselling are essential components of sexual and reproductive health and rights. Research has documented LGBTIQA+ people are as likely, or more...

Alone on an Island

Improving Access and Equity in a Post-Dobbs World

The frequency of pregnancy recognition across the gestational spectrum and its consequences in the United States

Despite a relatively permissive abortion law, women in the Netherlands encounter difficulties in accessing abortion care. Little is known about their experiences. This study explores women’s experiences with (online) abortion services and relevant health professionals’ experiences delivering care, with the goal of identifying key barriers encountered by abortion-seekers in the Netherlands. An exploratory qualitative research design with a constructivist approach and an abbreviated grounded theory method was used. Interviews with 20 women who had had an abortion and 14 health professionals who provide abortion care, and 200 emails of women seeking abortion care through the non-governmental organisation Women on Web, were coded inductively and deductively (using the Candidacy Framework) thereby generating themes. Abortion-seekers faced barriers including: (i) burden of taboo, (ii) vulnerability (emotional, financial, and social), (iii) health professional evaluation and (iv) disempowerment and distress. The overarching theme was women’s lack of autonomy in access to abortion care. The key barriers to abortion access in the Netherlands are the institutionalisation of taboo in abortion law and care, complex candidacy regulations, lack of permeability for certain marginalised groups, and women’s inability to speak openly about abortion. To increase the permeability of abortion care, and thereby women’s autonomy, legislators and policy-makers must trust women to make their own reproductive decisions and avoid actions that stigmatise abortion and hinder access to care, while actively developing systemic support for vulnerable groups.

Primary care and emergency medicine physicians may encounter patients who are seeking abortions, require miscarriage management or post-abortion care. Yet, little is known about their respective abortion training. We aimed to elucidate the interest and experience in abortion care among non-obstetrics/gynecology (OBGYN) residents. We conducted a cross-sectional survey of residents in family medicine, emergency medicine, internal medicine and pediatrics at a single academic institution in 2023-2024, evaluating interest and experience in abortion provision. Descriptive statistics were used for categorical variables, and comparisons were made via chi-square testing. 104 out of 297 residents completed the survey (26 family medicine; 22 emergency medicine; 36 internal medicine; 20 pediatrics; 35% response rate). The majority (94%) thought abortion should be legal in all or most cases, and 90% were interested in learning more about abortion provision. A majority were interested in being trained to provide medication abortions (87%), counsel on pregnancy options (94%), manage abortion complications (95%) and learn more about abortion policies (92%). A majority thought their patients would be interested in accessing abortion care in their primary care offices (88%) or the emergency room (86%). Despite significant interest, experience in abortion care was minimal; the majority reported never prescribing medications (71%) or performing manual vacuum aspirations (88%) for abortion or miscarriage management. While interest in abortion provision is high among residents in specialties beyond OBGYN, experience is limited. This represents an opportunity for expanded education and training in abortion care among these specialties.

Introduction The legal status of abortion has changed in the regions of former East Germany after reunification due to the adoption of restrictive West German abortion policies. The aim of this study was to evaluate the impact on attitudes towards abortion and the associated health care implications in Western and Eastern Germany. Materials and Methods Nationally representative data on public support for legally restricting abortion access were taken from the German General Social Survey and included the surveys 1992, 1996, 2000, 2006 and 2012 (N = 14 459). Two indicators of barriers to access to abortion care were calculated for each federal state, based on the number of abortion facilities and the proportion of women seeking abortion outside their state of residency. Data were analysed using latent class analysis. Results Results suggested that abortion attitudes could be classified into three distinct subgroups: 1) support for abortion access independent of womenʼs reason; 2) support on the basis of maternal or foetal health reasons but not for socio-economic reasons (e.g. financial restrictions); and 3) no support. The size of subgroups in favour of partial or complete restriction on abortion access increased in both regions over the study period and this trend could not be explained by changes in socio-demographic characteristics. Respondents living in a federal state with more barriers to access to abortion care were more likely to hold restrictive abortion attitudes. Conclusion Negative attitudes towards abortion have increased in Western and Eastern Germany during the two decades following reunification and may harm women by limiting acceptability and accessibility of abortion care. Abortion policies, public discourse and provision of abortion care should be informed by international guidelines protecting womenʼs health and rights.

Access to comprehensive abortion care is a vexed issue across the Commonwealth Caribbean. Abortion is criminalized with limited exceptions that have failed to translate to timely, safe, and accessible abortion care. This article examines how Barbados, Belize, Guyana, and St Lucia address law and policy issues relevant to the implementation of quality abortion care. This article asks two overarching questions: (1) to what extent do the abortion laws align with the World Health Organization's normative guidance on abortion care? and (2) how do abortion laws give effect to state obligations to respect, protect, and fulfill women's right to health under international human rights law? This research aims to bridge the gap in the current literature in the region by extending the scholarship beyond decriminalization. It provides a principled roadmap for change so that the provision of abortion care aligns with international public health guidance and human rights standards.

Access to abortion after decriminalization in Aotearoa New Zealand: A mixed-methods study of women's experiences and views.

Abortion is legal in every state of Australia, yet access to abortion over 20 weeks gestation is not universally guaranteed. Patients with indications outside of maternal medicine or fetal abnormalities experience particular challenges, including stigmatisation and limited service access. The aim of this study was to explore the lived experiences of women accessing abortion care over 20 weeks at the Royal Women’s Hospital for non-medical reasons, identify enablers and barriers to care and understand experiences of abortion care. Participants were recruited via convenience sampling once their abortion care had been booked. Semi-structured interviews were conducted in person or online. Data were analysed via a reflexive thematic analysis. 15 women participated in the study. A total of five themes and 15 sub-themes were identified which described social stressors and systemic barriers to abortion access, including multiple competing personal stressors, compromised autonomy, navigating a complex abortion service system and late diagnosis of pregnancy as compounding reasons for delayed access to abortion care. Enablers to abortion care recognised the importance of safe, holistic, and time-sensitive care for all. Additional research is needed to understand the experiences of women who attempted to access abortion care over 20 weeks but were unable to do so and forced to continue their pregnancies Greater access to abortion at 20 weeks and over for reasons beyond maternal medicine and fetal abnormalities is needed throughout Victoria and Australia-wide.

What about access to birth control and emergency contraception now that abortion rights are overturned?

SOCIAL SCIENCE ORAL ABSTRACTS: Patient experiences with protestors while accessing abortion care in Jackson, Mississippi

Experiences of delay-causing obstacles and mental health at the time of abortion seeking

Lack of access to safe abortions continues to be a major sexual and reproductive health concern. Adolescents can face barriers to safe abortions due to the unique implications of their age. Understanding adolescent abortion experiences and care trajectories is critical. Qualitative and quantitative evidence is analysed from interviews with 313 adolescents aged 10-19 years who sought abortion-related care in public health facilities in Addis Ababa (Ethiopia), Lilongwe (Malawi), and Lusaka (Zambia) between April 2018 and September 2019. The trajectories framework is used to understand how adolescent abortion-related care-seeking differs across a range of socio-legal national contexts. A comparative study design incorporates varying levels of restriction on access to abortion: Ethiopia (legal on broad social or economic grounds, services implemented); Zambia (legal on broad social or economic grounds, complex services with barriers to implementation and information provision); and Malawi (legally highly restricted). Most adolescents (n = 97, 98%) in Ethiopia obtained a medically safe abortion, and most adolescents (n = 70, 64%) in Zambia and almost all adolescents (n = 94, 94%) in Malawi obtained a less medically safe abortion. There is a significant association between country and whether an adolescent tried to end a pregnancy before coming to the facility, X²(2, N = 313) = 135.93, p < 0.001. In Malawi 97% (n = 101) of adolescents had sought to end the pregnancy before coming to the facility, compared to 18% (n = 18) in Ethiopia. Cross-country variations in the relative safety of the abortion and type of care sought by adolescents reflect national laws, policies and service availability. The most facility-based abortions were recorded where care is most accessible (Ethiopia), and most non-facility-based and least safe abortions were recorded where care is the most restricted (Malawi). Across all countries, adolescents experienced delays to their care-seeking; 39% (n = 39), 71% (n = 74), and 66% (n = 73) in Ethiopia, Malawi, and Zambia respectively. Adolescents reported high levels of respectful treatment across countries, with a minority reporting negative experiences. A minority of adolescents in each country reported that unofficial money was paid to facility staff. There were different experiences of post-abortion contraception in the three countries, including an absence of choice. Adolescents' trajectories - particularly those involving multiple attempts and barriers to achieving abortion care - require tenacity and determination. Our analyses show that less restrictive abortion policies and accessible abortion services improve adolescent chances to access abortion care.

Expanding the Pool of Abortion Providers: Nurse–Midwives, Nurse Practitioners, and Physician Assistants