Legal Abortion Research Articles

Getting into Good Trouble: A case study on getting started in organized physician advocacy

The Good Trouble Coalition (GTC) was established in 2022 by healthcare and public health practitioners in Indiana, aiming to channel frustration into action amidst the politicization of public health issues during the COVID-19 pandemic. This paper focuses on the origins of GTC, detailing the motivations behind its formation, particularly the need to counter legislative attacks on public health and the patient-doctor relationship. It outlines the critical steps required to establish a nonprofit advocacy group, including gathering a multidisciplinary team, creating a mission statement, incorporating as a 501(c)(4), and securing funding and resources. Key actions taken by GTC in its first year include publishing an open letter against abortion bans, organizing legislative testimonies, engaging with media, and holding public protests. By sharing GTC’s journey, the paper aims to provide a roadmap for other healthcare professionals and public health workers interested in organizing for civic advocacy and promoting health equity.

Beliefs and behaviors regarding abortion counseling among U.S. clinicians caring for adolescents.

To determine clinician factors associated with discussing abortion during pregnancy options counseling among adolescents. We recruited and surveyed a convenience sample of U.S. clinicians who care for pregnant adolescent patients (N=146). Clinicians were recruited at a national conference, through listservs, and via a physician mailing list. We used chi-square tests to analyze differences in our primary outcomes (routinely discussing abortion, routinely providing abortion referrals, and not routinely advising patients seeking abortion against termination) by clinician demographics, beliefs, and practice settings. Fifty-seven percent of clinicians reported routinely discussing abortion with adolescent patients, 58% routinely referred for abortion, and 76% did not routinely advise against termination. Female gender, pediatric specialty, and practicing in an academic setting were associated with routinely referring for abortion and not routinely counseling against abortion (p<0.05). Additionally, state abortion laws at the time of the survey were associated with abortion discussion and referrals. Having "a personal objection to abortion" or "belief that abortion will harm patients" were negatively associated with each outcome (p <0.05). Clinician demographics and personal beliefs were associated with differences among counseling. Although this was a small exploratory study, our findings highlight important clinician-level barriers to adolescents' access to abortion counseling and care.

Pregnancy resulting from sexual violence committed by the intimate partner: characterization of the crime and abortion provided for by law

Introduction: intimate partner violence is highly prevalent in Brazil. Among the serious consequences for women’s health, pregnancy resulting from this circumstance stands out. Objective: To compare pregnancy and abortion characteristics among women with sexual violence committed by an intimate partner and an unknown aggressor. Methods: cross-sectional study with women aged ≥14 years with pregnancies resulting from sexual violence and legal abortion request attended at the Pérola Byington Hospital, São Paulo, Brazil, between 1994 and 2018. They compared 1,881 cases in which the sexual offender was a stranger with 192 cases committed by the intimate partner. The variables considered sociodemographic data of the pregnant woman, sexual violence, legal procedures and abortion, analyzed in SPSS 20.0 software. Study approved by the Research Ethics Committee of the São Francisco de Barreiras University Center, No. 3,668,297. Results: pregnant women who were assaulted by an intimate partner had a higher mean age (27.4±6.8 years), reported less work (p=0.032) and were not in a union (p=0.010). Cases involving an intimate partner had a higher frequency of physical violence (p&lt;0.001) in the private space (p&lt;0.001), with less search for the pregnant woman by the police (p=0.013) and medico-legal examination (p=0.034). Abortion was similar in both groups, but dropout from the procedure was higher in cases with an intimate partner (p=0.001). Conclusion: when pregnant with sexual violence perpetrated by an intimate partner, women have different trajectories from those raped by strangers to resort to legal abortion. The lesser disclosure to the police of the crime and the greater withdrawal of legal abortion may suggest an intimidating role of the aggressor intimate partner.

Weak Institutions, Strong Movements: The Uneven Implementation of Abortion Policy in Latin America

Across Latin American countries, there is remarkable heterogeneity in abortion legislation, ranging from full prohibition to legal elective abortion.1 However, abortion policy does not seem to clearly map onto implementation on the ground. On the one hand, even in countries with very restrictive abortion laws, (clandestine) abortion rates are comparatively high, and legislation that criminalizes abortion is rarely enforced (Blofield 2006; Htun 2003). On the other hand, in countries that allow abortion under all or some circumstances, access to abortion is not guaranteed. In Argentina, for instance, different reports have stressed the difficulty in accessing abortion procedures both before and after legalization was enacted in early 2021.2

Judicial Federalism and Abortion in Mexico and the United States

As the US Supreme Court was preparing to overturn Roe v. Wade, the Mexican Supreme Court issued a series of sweeping rulings to liberalize abortion—part of a larger trend across Latin America (Daby and Moseley 2022; Fernandez Anderson 2017; Reuterswärd 2020; Ruibal 2014). Mexico has created a nationwide standard of access to abortion services, whereas the United States has abandoned universal legal abortion and embraced a patchwork system in which each state has different laws regulating reproductive healthcare. Why are these two neighbors on such divergent paths? This contribution to the symposium compares the ways that federalism and judicial politics have interacted in Mexico and the United States to explain the different trajectories of abortion policy. The divergent paths of the United States and Mexico can be explained by the two countries’ different experiences with democracy and political and institutional differences between the judiciaries. A different civil-society and constitutional context also has played a role.

“I am putting my fear on them subconsciously”: a qualitative study of contraceptive care in the context of abortion bans in the U.S.

BackgroundSince the Dobbs vs. Jackson Women’s Health Organization decision in June 2022, providers throughout the U.S. have been navigating the shifting legal landscape of abortion bans, which diminish the delivery of evidence-based healthcare. The Dobbs decision has had a detrimental impact on medical training, the physician–patient relationship, and provision of medical care. However, few studies have captured the effects on providers in adjacent fields, including contraceptive care. Our objective was to examine the impact of Dobbs on contraceptive care.MethodsWe conducted semi-structured in-depth interviews (August 2022–July 2024), with 41 contraceptive healthcare providers across the US, with the majority (63%) in abortion restrictive states. We utilized deductive thematic analysis to assess providers’ practice changes and experiences related to contraceptive services.ResultsIn reaction to the Dobbs decision, providers noted increased requests for contraception, especially for highly effective methods. Providers worried that certain methods, such as IUDs or emergency contraception, would become restricted, and mentioned advance provision of pills and other ways that they would try to ensure supplies. Providers also discussed that their patients were worried about threats to contraception, including for adolescents. Some expressed concern, however, that the abortion bans may prompt providers to overemphasize high-efficacy methods with directive counseling. Providers shared that it was stressful to practice in contexts of uncertainty, with shifting abortion policies affecting contraceptive care, including emergent needs such as providing contraceptive services to out-of-state patients before they go home. Several providers shared that they felt an increased importance of their role in their communities, and a deepened commitment to advocate for their patients.ConclusionsAbortion restrictions profoundly impact providers’ contraceptive counseling and care. The effects of Dobbs on providers and their clinical practices underscore providers' legally precarious position in today’s reproductive health landscape. Attention to contraceptive access and person-centered care has become a salient public health need across the U.S. The long-term impacts of limited reproductive rights may stretch an already under-resourced healthcare system and further emphasize moral pressures.

Correction to: Engagement in Pro-Choice Protests: The Role of Gender, Feminism, Gender Collective Self-Esteem, and Reactance Against Abortion Bans

Correction to: Engagement in Pro-Choice Protests: The Role of Gender, Feminism, Gender Collective Self-Esteem, and Reactance Against Abortion Bans

Self‐reported mental health and the Dobbs decision: Variation by State abortion laws

AbstractWhen a US Supreme Court ruling allowed states to ban abortion, women of childbearing age in the states where abortion became illegal reported higher rates of anxiety symptoms compared to similar‐aged women in other states and older women in the same states. This study highlights how people respond to major policy changes and underscores the importance of mental health as a measure of well‐being for policymakers and researchers.

The 2023 Gerard W. Ostheimer Lecture. A Contemporary Narrative Review of Maternal Mortality and Morbidity: Opportunities to Improve Peripartum Outcomes.

The Gerard W. Ostheimer lecture is given annually to members of the Society for Obstetric Anesthesia and Perinatology. This lecture summarizes new and emerging literature that informs the clinical practice of obstetric anesthesiology. This is a narrative review of 2022 literature pertinent to maternal morbidity and mortality in all income settings globally. Themes associated with worse maternal mortality rate (MMR), challenges health care workers face, public health priority areas, and initiatives to help countries achieve the United Nations Sustainable Development Goal targets for MMR are discussed. MMRs are higher in low- and middle-income countries (LMICs) compared to high-income countries (HICs). Cesarean delivery rates are rising most rapidly in LMICs, warranting urgent maternal health care workforce planning efforts in these settings. Globally racial, ethnic, and geographical disparities in maternal mortality continue to be evident in global health care settings. In the United States, the MMR is rising. The evolving changes in abortion legislation in the United States may further negatively impact maternal morbidity and mortality. The need to implement American Society of Anesthesiologists-recommended obstetric anesthesia quality metrics to facilitate benchmarking and to improve patient experience and outcomes is discussed as well as the need for professional society guidance on minimum staffing levels in American labor and delivery units.

Cyclopia: A rare case of congenital anomaly associated with holoprosencephaly

Cyclopia is a rare congenital disorder characterized by the fusion of the eyes, typically as part of holoprosencephaly, resulting from a failure of the forebrain to divide during fetal development. Occurring in approximately 1 in 13,000 to 20,000 births, many cases go undetected due to early miscarriages. The condition is associated with significant facial deformities, including an absent or severely underdeveloped nose and malformed ears. This case report details a 31-year-old woman who presented at 27 weeks of gestation with abdominal pain and bleeding. Ultrasound revealed a single-lobed brain, hypotelorism, and cyclopia in the fetus. A vaginal delivery was planned, resulting in the birth of an 800-gram baby boy with severe facial anomalies who died shortly after birth. Holoprosencephaly encompasses varying degrees of brain malformation, with cyclopia being the most severe form. The absence of effective treatments necessitates early diagnosis and potential legal abortion to prevent suffering. Risk factors include maternal dietary choices and genetic mutations, particularly in the Sonic Hedgehog (SHH) gene. Awareness and education regarding these risks are crucial for prospective parents, as early detection through ultrasound can guide management strategies and reduce harm to both the newborn and the mother.

Ghana abortion care—a model for others: analysis of the 2017 Ghana Maternal Health Survey

BackgroundAbout 5-13% of maternal mortality is directly related to unsafe abortion care. Despite the cultural stigmatization of abortions, Ghana has progressive abortion laws, healthcare guidelines, and clinical outcomes. ObjectiveOur study's primary aim was to characterize abortion outcomes in Ghana. Our secondary aims include observing for reasons leading to abortion complications and treatment of these complications. Study DesignWe utilized data from the 2017 Ghana Maternal Health Survey. We examined questions focusing on reasons for abortion, methods used for abortion, healthcare setting for abortion, and health issues post-abortion. We performed descriptive and inferential statistics including cross tabs with chi-square analysis and logistic regression models. ResultsBetween 2012 and 2017, 1,425 women reported and completed the abortion-related questions. For those obtaining an abortion for health reasons, 69% had a surgical compared to herbal or medication-based abortion (p<0.001), 94% had a medical compared to non-medical facility-based abortion (p<0.001), and 21% had health problems related to the abortion within one month (p=0.035). Women's reasons for receiving an abortion did not affect treatment rates after complications. There was no difference in medical-based versus non-medical based abortion and regarding the occurrence of an abortion-related complication, or receipt of treatment for this complication within one month after the abortion. Those with a tertiary level of education or who know abortions are legal were more likely to have a surgical and medical facility-based abortion. ConclusionWhile Ghana has room to improve the safety and accessibility of abortion services, our analysis suggests abortions in Ghana, regardless of reason given for seeking the service or method of abortion, appear safe. Translating Ghana's approach to abortion could minimize unsafe abortions globally.

Legalitas Tindakan Aborsi (Abortus) Akibat Perkosaan Incest Ditinjau dari Hukum Pidana Adat di Wilayah Masyarakat Adat Kabupaten Timor Tengah Selatan

The Timorese tribe has a pamali or prohibition not to be related or marry the same clan in one tribe or blood relations for people who are related by blood will be subject to customary sanctions by the traditional chief. The case of incest rape occurred in Nuapin Village, Fatumnasi District, South Central Timor Regency, this rape resulted in the victim experiencing an unwanted pregnancy by the victim and her family because the victim was pregnant with a child from her blood family which is prohibited in Timorese customary law, so she chose to have an abortion. Law No. 36 of 2009 concerning health and its Implementing Regulations excludes the act of abortion due to rape even though it is prohibited in the Criminal Code. In this case, the act of abortion is carried out as a result of incest rape and will be reviewed based on customary criminal law. The type of research used in this study is empirical research with a sociological juridical approach, namely field research whose object is about events and phenomena that occur in society. Data collection was carried out with two events, namely interviews with 4 people and literature studies. The data obtained were then presented in a qualitative descriptive manner. The results of this study show that: (1) The existence of criminal law prohibits the legalization of abortion due to incest rape, abortion is only allowed in emergency medical conditions in accordance with Law Number 36 of 2009 and Government Regulation Number 61 of 2014. (2). The legality of customary criminal law for abortion due to incest is carried out in Nuapin Village because it is considered to violate customary and pamali law.

Abortion and Women’s Future Socioeconomic Attainment

Abortion is a safe and common medical procedure. Roughly one in four women in the United States will have an abortion before the end of her reproductive years. Because of how common this experience is and how rapidly abortion policy is shifting, understanding the relationship between abortion and women’s socioeconomic futures is well worth exploring. Extant research has demonstrated that the transition to parenthood is a critical inflection point in women’s socioeconomic trajectories, often leading to poorer outcomes. In this article, we connect previous sociological work elucidating mechanisms of socioeconomic stratification and gender by considering the relationship between abortion use and access and future socioeconomic outcomes such as education, income, and financial stability—as measured by several measures, including evictions, debt, ability to pay bills, and a separate index of economic instability. We use national longitudinal survey data to assess socioeconomic outcomes associated with abortion using two statistical approaches. We find that women who lived in a location with fewer abortion restrictions in adolescence, and women who had an abortion, compared to a live birth, in adolescence, are more likely to have graduated from college, have higher incomes, and have greater financial stability at two time-points over an almost 25-year period. Our results provide evidence that policy environments allowing access to abortion, and teenagers having the option to use abortion to avoid early parenthood, are important axes along which women’s economic lives are shaped. Our research implies that the widespread abortion bans and restrictions in the United States are likely to lead to lower educational attainment and adult economic stability among women living under such restrictions, as compared to women in locations with better access to abortion.

Abortion access barriers shared in “r/abortion” after Roe: a qualitative analysis of a Reddit community post-Dobbs decision leak in 2022

With drastic changes to abortion policy, the months following the Dobbs leak and subsequent decision in 2022 were a uniquely uncertain and difficult time for abortion access in the United States. To understand experiences of challenges to abortion access during that time, we used a hybrid inductive and deductive thematic coding approach to analyse descriptions of barriers and their impacts shared in an abortion subreddit (r/abortion). A simple random sample of 10% of posts was obtained from those shared from 02 May 2022 through 23 December 2022; comments were purposively sampled during the coding process. In this sample of submissions (n = 523 posts, 88 comments), people described structural barriers identified in past research, including state abortion bans and gestational limits, high costs, limited appointment availability, and long travel required. Posters also commonly described known social barriers, including limited social support and abortion stigma. Several impactful barriers not well-described in past research emerged inductively, including wait time for receiving mail-ordered abortion medication, low credibility of online ordering platforms, and concerns about legal risks of accessing abortion or related medical care. The most common consequences of experiencing barriers were adverse mental health outcomes, delayed access to care, and being compelled to self-manage their abortion because of access barriers. This analysis provides timely insights into the experiences and impacts of abortion access barriers in a group of people with a range of engagement with clinical abortion care, lived experiences, and points in their abortion processes, with public health implications for mental health and abortion access.

What Counts as Global Health?

Safe abortion access is an essential aspect of reproductive justice and key to reducing global rates of maternal mortality, yet within the global heath enterprise, the rhetoric of sexual and reproductive health and rights has not yet been realised in practice. Access to safe legal abortion remains inequitable globally and within nations and deaths due to unsafe abortion take their highest toll in the Global South in jurisdictions with restrictive laws. Clandestine abortion access activist networks have been filling this gap offering life, dignity and futures to the people who seek their services. What should we make of clandestine activist networks around the world that help people access medication abortion? Such groups have been important players in women’s reproductive health in many jurisdictions for decades – but have typically, by necessity and design, flown under the radar. If visibility, accountability and humanitarian appeal are essential characteristic of global health work, how do we acknowledge and understand the work of clandestine abortion access activist networks? Does it count as global health? In this essay I offer the notion of ‘critique in action’ to further our understanding of such networks and also consider the idea of abortion access activist networks as an anti-regime of global health.

Mississippi Abortion Clients' Strategies to Pay for Abortion Care and Manage Economic Hardship.

Abortion clients who experience economic hardship face barriers paying for abortion care. Between September 2020 and June 2021, we conducted a facility-based survey with 211 abortion clients who obtained care in Mississippi, and 25 respondents completed in-depth interviews. We computed the frequency with which survey respondents used social network-based, agency-based, and individual strategies to pay for care and we employed thematic analysis to explore in-depth interviewees' decision-making and experiences with these strategies. Overall, 93% used at least one strategy to pay for their abortion: 62% sought help from social networks; 61% received assistance from abortion funds (non-profit organizations that help people pay for abortion care); and 47% relied on individual strategies, such as postponing routine expenses. Interviewees often noted it was difficult to use these strategies and doing so adversely affected their economic stability. These findings support the need for insurance coverage and expanded financial assistance for abortion seekers, particularly those now forced to travel following abortion bans.

Clinician Perspectives on Adolescent Contraceptive Counseling Following Dobbs v. Jackson: Implications for Young People's Contraceptive Autonomy

ObjectiveThe objective of this study is to understand whether clinicians who provide contraceptive counseling to adolescent patients perceive that the Dobbs decision has influenced their counseling. Study DesignWe conducted in-depth interviews with a convenience sample of 16 clinicians who provide contraceptive counseling to adolescents at the American Academy of Pediatrics annual conference in October 2022. We used thematic content analysis and an iterative process of constant comparison to identify themes inductively. This analysis focused on participants’ perception of if and how the Dobbs decision has or will influence their contraceptive counseling with adolescents. ResultsMost clinicians in our study reported that the Dobbs decision influenced their contraceptive counseling. This included promoting long-acting, reversible methods more so than pre-Dobbs, and explicitly considering changing state-level abortion laws and restrictions. Many clinicians openly noted that their personal preferences influence their counseling, such as prioritizing pregnancy prevention and encouraging patients to use particular methods. ConclusionWe found that most clinicians in our sample acknowledged that the Dobbs decision has influenced their contraceptive counseling practices with adolescents. Clinicians’ responses demonstrate that, in many instances, the Dobbs decision motivated them to focus on method effectiveness, leading to tiered and directive contraceptive counseling. We recommend practice changes to support comprehensive contraceptive care provision, provider trainings in unbiased counseling, and developmentally tailored decision aids are needed to ensure that adolescent patients’ autonomy is prioritized over a singular focus on pregnancy prevention.

Impact of State Abortion Policies on Family Medicine Practice and Training After Dobbs v Jackson Women's Health Organization.

The Dobbs v Jackson Women's Health Organization (Dobbs) Supreme Court decision revoked the constitutional right to abortion. Now, restrictive state abortion laws may contribute to the shortage and strain already felt in primary care practice, especially related to the provision of reproductive health care. The purpose of this study is to evaluate perceived impacts of state abortion legislation on family medicine clinicians' practice and medical education regarding reproductive health care. Ten questions were added to the 2022 Council of Academic Family Medicine Educational Research Alliance general membership survey to evaluate impact on relevant themes in reproductive health care and training after the Dobbs decision. Responses were categorized by severity of restriction of state abortion policies. Of 1,196 respondents, 49.7% reported employment in states with very restrictive or restrictive abortion policies. The 991 respondents with clinical responsibilities reported significant (P <.05) changes in their counseling practices, clinical decision making, worry of legal risks, and trust in patients' self-reported reproductive medical history, compared with peers in protective states. Perceived patient trust toward clinicians remained unchanged. Almost one-half of clinical respondents reported an absence of reproductive health care guidance or recommendations. Restrictive abortion policies significantly (P <.05) reduced the desirability and confidence in resident training programs. Reported changes to clinical activities and training, coming early after the Dobbs decision, affect our current and future workforce and therefore, our patients. Future studies are needed to document continued impact of state restrictions and inform policy to support family medicine clinicians in reproductive health practice and education.

Abortion in South-Africa: Does a liberal legislation really impact safe access and use?

The World Health Organization (WHO) considers comprehensive abortion care as part of their essential healthcare service package, which includes the provision of information, abortion management, and post-abortion care. The WHO estimated that globally, 45% of all induced abortions were unsafe, and it noted that nearly half of all the abortions occurred under the least safe circumstances in Africa. Abortion has been legal in South Africa since the implementation of the Choice of Termination of Pregnancy (CTOP) Act (No. 92 of 1996), which was a significant departure from the country's previously restrictive abortion laws. While the CTOP Act (1996) has made provision for access to safe abortion services and pre- and post-abortion counselling, this has not been effectively implemented into effective service delivery. It's estimated that between 52% and 58% of abortions take place in informal medical settings, and that only 7% of the public health facilities in South Africa were performing abortion services in 2017. The WHO noted that the lack of access to safe, affordable, timely, and respectful abortion care, and the stigma associated with abortion pose risks to women's physical and mental well-being throughout the life-course. The aim of this paper was to explore how women in South Africa experience and cope with induced abortion. Additionally, this research looks at how religion, culture and stigma, impact abortion and mental health post-abortion of South African's women. This study utilises data from the latest South African Demographic and Health Surveys (SADHS), in 2016, which includes data from 8514 women aged 15-49 years. This study highlights the need for more data and research related to challenges and experiences of South African women around mental health and the nature of abortion within the country. In this interview conducted by Professor Jean-Pierre Bouchard, population analysts Robynn Ashely Hera and Siposethu Nojoko together with demographer Professor Nancy Stiegler from the University of the Western Cape discuss safe and unsafe abortion incidence and access and the psychological effects thereof.

Mifepristone-Misoprostol Regimen vs. Surgical Abortion: Evaluating Pregnancy Termination Options in Bangladesh

Background: Access to safe and effective abortion services plays a vital role in safeguarding women's reproductive health, ultimately contributing to their overall well-being. This is particularly relevant in Bangladesh, where the legality of abortion is contingent upon specific circumstances. Therefore, ensuring women have the autonomy to choose between safe and effective termination methods becomes crucial. Objective: The study aims to see explore the efficacy, safety, and accessibility of mifepristone-misoprostol regimen and surgical abortion methods within the context of Bangladesh. Methods: This investigation employed a cross-sectional observational design, conducted within the Department of Obstetrics and Gynecology at Dhaka National Medical College in Bangladesh. The study spanned one year, commencing in March 2023 and concluding in February 2024. To ensure a representative sample of the patient population seeking abortion services, consecutive sampling was utilized. This approach involved recruiting all patients admitted during the designated timeframe who fulfilled the pre-established inclusion and exclusion criteria. Ultimately, the study enrolled 104 participants, a sample size determined by the number of admissions fitting the criteria within the one year. Results: The study found no significant difference in age distribution between women choosing medical or surgical abortion, with both groups mainly consisting of women aged 18-25. Overall complication rates were similar, but medical abortion had a higher need for additional procedures and longer stays, while surgical abortion required more bleeding observation. Pain experiences differed significantly, with no women in the medical group reporting no pain and a higher prevalence of moderate pain compared to surgical abortion. Women undergoing medical abortion were slightly more likely to experience complications overall, and primigravid women (first pregnancy) were significantly more likely to experience complications than multigravid women. Conclusion: Our findings suggest comparable safety profiles for both surgical and medical abortion procedures within the studied population. This indicates that surgical abortion can be a safe and effective option alongside medical abortion, potentially expanding the range of choices offered to women.