Abortion Clinics Research Articles

Differences in abortion service-delivery in clinics by state policy context in 2017

Introduction In addition to monitoring the number and location of abortion clinics nationwide, it is important to examine other aspects of service-delivery, such as cost, and number of days abortions are provided, because they influence the accessibility of abortion care. Moreover, state policies can affect the types of care that are provided. This study examines differences in abortion service-delivery in clinics by state policy climate in 2017. Method Data for this study are from the Guttmacher Institute’s 2017 Abortion Provider Census, which collected information from all known abortion-providing facilities in the United States. This analysis focuses on the 808 clinic facilities that provided 95% of abortions that year. Outcomes include the cost of abortion care, maximum gestation at which abortions were offered, number of days clinics provided abortions, and other types of non-abortion services offered. Weights were constructed to account for non-responding facilities. Measures were calculated nationally and according to whether the clinic was in a state with a policy context that we categorized as hostile, middle-ground or supportive of abortion rights. Results In 2017, patients paid an average of $549 for a surgical abortion at 10 weeks gestation; without adjusting for cost-of-living, the amount was highest in middle-ground states ($592) and lowest in hostile states ($534). 64% of clinics offered abortion up to 11 weeks gestation, 22% did so up to 20 weeks, and 13% offered abortion at gestations up to 22 weeks. A slightly higher proportion of clinics in supportive states than hostile offered abortions after 22 weeks. 87% of clinics offered family planning services beyond post-abortion contraception, and the proportion was higher in supportive (93%) than in hostile states (75%). Nationally, clinics provided abortions for a median of 3 days per week. Nearly half of clinics in supportive states provided abortions > =5 days per week (46%), compared to 29% in hostile and middle-ground states. Conclusions Clinics operating in states that are hostile to abortion rights provide abortion services on fewer days and offer fewer non-abortion services. People residing in these states may encounter barriers not just to abortion, but to the wider range of sexual and reproductive health care they need.

Satisfaction with medication abortion and marijuana use: A prospective cohort study

ObjectivesThis exploratory study compared self-reported satisfaction rates and pain scores between patients who used marijuana during their medication abortion versus non-users. Study designWe recruited medication abortion patients at a University-affiliated abortion clinic in Denver, Colorado. Participants completed a pre-abortion questionnaire, pain diary, and follow-up survey that assessed satisfaction with pain control, symptoms, and abortion experience. Using medians test, we compared the sums of median satisfaction scores between patients who used marijuana versus non-users. Based on diary entries, we also compared reported pain over 24 h after misoprostol (area under the curve [AUC]) between cohorts. ResultsWe enrolled 51 participants; 16 marijuana users and 35 non-marijuana users. Marijuana users and non-users had similar sums of median satisfaction scores (22 vs. 20 out of 30, p = 0.90) and median question-specific satisfaction scores (range 7–8 vs. 6.5–8, p = 0.6–1.0). Sixteen marijuana users (100%) and 20 (57%) non-users completed their pain diary; median AUCs for pain were similar (65.0 vs. 59.5, p = 0.73). Thirteen (81%) patients subjectively correlated marijuana use with pain reduction, seven (44%) with anxiety reduction, and six (38%) with nausea/vomiting improvement. ConclusionsWe found no significant difference in measures of medication abortion satisfaction and pain when comparing marijuana users to non-users. However, marijuana users often attributed symptom improvement during their medication abortion to marijuana use. ImplicationsUntil randomized studies are available, clinicians can counsel patients that marijuana use may not necessarily affect satisfaction or pain with medication abortion. It remains unknown whether marijuana has potential benefits in a marijuana-naïve population undergoing medication abortion. Future studies should explore the role that marijuana and its derivatives may play for pain and side effect management during medication abortion among marijuana-naïve patients.

Telemedicine for Medication Abortion: The Time Is Now

This review will provide an overview of the current restrictions to medication abortion in the USA, strategies for incorporating telemedicine into medical abortion care, and new evidence on the efficacy and safety of telemedicine as a means to provide medication abortions. Newly published data from the TelAbortion study, the first direct-to-patient medication abortion service in the USA, shows that it is as safe, successful, and acceptable to patients as previous international data on similar care delivery systems. Other groups have continued to build upon the existing body of literature supporting the safety of telemedicine-facilitated medication abortion in other countries. All recent studies continue to support telemedicine as a desired method to increase abortion access in a variety of geographical settings. Medication abortion is a safe and common method to end unwanted pregnancy but is often inaccessible to patients remote from an abortion clinic. Telemedicine can be safely utilized for counseling, provision, and follow-up of medication abortion. However, its implementation is limited in the USA due to restrictive, medically unnecessary prescribing laws. Research indicates that telemedicine-based medication abortions have similar rates of completion as in-person medication abortions, with equivalent complication rates. Patients choose telemedicine for medication abortion for a variety of reasons, including privacy, accessibility, and personal preference, but generally report high rates of satisfaction with the method. These data argue for the expansion of telemedicine for medication abortion, expanding the availability of safe abortion with fewer logistical burdens to patients seeking care.

What's Old Is New Again: How State Attorneys General Can Reinvigorate Udap Enforcement to Combat Crisis Pregnancy Center Deception

For decades, abortion opponents have set up thousands of crisis pregnancy centers (CPCs) across the country to dissuade women from terminating their pregnancies. Although some CPCs make their anti-abortion stance clear, others rely on deception as part of their operational model. Many CPCs advertise as abortion clinics and then lie to unwitting consumers about whether they are pregnant and how quickly they should seek medical assistance. As a result, some women who mistakenly visit CPCs are delayed in obtaining abortion services for so long that they forfeit the right to abortion altogether. Cities and states attempting to rein in this deception over the last decade have enacted laws requiring CPCs to disclose the true nature of their services. But in 2018, the Supreme Court declared such CPC disclosure laws unconstitutional, leaving advocates in search of an alternate solution. This Article sketches a roadmap for state governments wishing to respond to CPC fraud in the wake of this new constitutional constraint. It retraces a largely forgotten strategy of using Unfair, Abusive, and Deceptive Practices Acts (UDAP laws) to investigate and enjoin CPCs’ harmful practices and explores the opportunities and challenges presented by adapting UDAP laws to the modern CPC problem. Seizing on the rising importance of state attorneys general as national policymakers, this Article lays out a pragmatic path forward for curbing CPC deception that interferes with women’s reproductive decisionmaking autonomy.

Contextualizing Medicaid reimbursement rates for abortion procedures

ObjectiveLow Medicaid reimbursement rates have been cited as a key threat to abortion clinic sustainability in the United States. This study examines differences between Medicaid and Medicare reimbursements for abortion and miscarriage management procedures under a fee-for-service (FFS) model. Study designUsing 2017 Medicaid and Medicare Physician fee schedules, we extracted reimbursement data for the two most commonly-billed abortion procedures and two miscarriage management procedures for 45 states and the District of Columbia (DC). We compared Medicaid and Medicare reimbursement rates for each procedure by state. ResultsMedicaid reimbursement rates for both procedures varied widely across the states. Medicaid rates for second-trimester abortion procedures had the widest range; $79–$626. Median Medicaid reimbursement rates were lower than median Medicare rates for first- and second-trimester abortion procedures. Median reimbursement rates for first-trimester induced abortion were lower than median reimbursement rates for miscarriage management for both Medicaid and Medicare. ConclusionOur findings indicate that Medicaid reimbursement rates for abortion are low; the median patient cost for a first- and second-trimester abortion have been reported as $490 and $750, respectively. Median Medicaid reimbursement rates for a first- and second-trimester abortion covers approximately 37% and 41% of patient costs for a first- and second-trimester abortion. Further, while induced abortion procedures are similar to miscarriage management procedures, Medicaid and Medicare reimbursement rates are lower for first- and second-trimester abortion procedures. Implication statementEnsuring reimbursement rates are closely aligned with procedural costs bolsters provider willingness to accept Medicaid. Data that highlights the potential impact of fee-for-service reimbursement rates on healthcare provision and ultimately patient access can help inform healthcare policies. This is especially important as more states consider expanding Medicaid coverage of abortion.

Medication abortion use among low-income and rural Texans before and during state-imposed restrictions and after FDA-updated labeling

In 2013, the Texas legislature passed House Bill 2, restricting use of medication abortion to comply with Food and Drug Administration labeling from 2000. The Food and Drug Administration updated its labeling for medication abortion in 2016, alleviating some of the burdens imposed by House Bill2. Our objective was to identify the impact of House Bill 2 on medication abortion use by patient travel distance to an open clinic and income status. In this retrospective study, we collected patient zip code, county of residence, type of abortion, family size, and income data on all patients who received an abortion (medication or aspiration) from 7 Texas abortion clinics in 3 time periods: pre-House Bill 2 (July 1, 2012-June 30, 2013), during House Bill 2 (April 1, 2015-March 30, 2016), and post-Food and Drug Administration labeling update (April 1, 2016-March 30, 2017). Patient driving distance to the clinic where care was obtained was categorized as 1-24, 25-49, 50-99, or 100+ miles. Patient county of residence was categorized by availability of a clinic during House Bill 2 (open clinic), county with a House Bill 2-related clinic closure (closed clinic), or no clinic any time period. Patient income was categorized as ≤110% federal poverty level (low-income) and >110% federal poverty level. Change in medication abortion use in the 3 time periods by patient driving distance, residence in a county with an open clinic, and income status were evaluated using χ2 tests and logistic regression. We used geospatial mapping to depict the spatial distribution of patients who obtained a medication abortion in each time period. Among 70,578 abortion procedures, medication abortion comprised 26%, 7%, and 29% of cases pre-House Bill 2, during House Bill 2, and post-Food and Drug Administration labeling update, respectively. During House Bill 2, patients traveling 100+ miles compared to 1- 24 miles were less likely to use medication abortion (odds ratio, 0.21; 95% confidence interval, 0.15, 0.30), as were low-income compared to higher-income patients (odds ratio, 0.76; 95% confidence interval, 0.68, 0.85), and low-income, distant patients (adjusted odds ratio, 0.14; 95% confidence interval, 0.08, 0.25). Similarly, post-Food and Drug Administration labeling update, rebound in medication abortion use was less pronounced for patients traveling 100+ miles compared to 1-24 miles (odds ratio, 0.82; 95% confidence interval, 0.74, 0.91), low-income compared to higher-income patients (odds ratio, 0.77; 95% confidence interval, 0.72, 0.81), and low-income, distant patients (adjusted odds ratio, 0.80; 95% confidence interval, 0.68, 0.94). Post-Food and Drug Administration labeling update, patients residing in counties with House Bill 2-related clinic closures were less likely to receive medication abortion as driving distance increased (52% traveling 25-49 miles, 41% traveling 50-99 miles, and 26% traveling 100+ miles, P < .05). Geospatial mapping demonstrated that patients traveled from all over the state to receive medication abortion pre-House Bill 2 and post-Food and Drug Administration labeling update, whereas during House Bill 2, only those living in or near a county with an open clinic obtained medication abortion. Texas state law drastically restricted access to medication abortion and had a disproportionate impact on low-income patients and those living farther from an open clinic. After the Food and Drug Administration labeling update, medication abortion use rebounded, but disparities in use remained.

Safety of deep sedation without intubation during surgical abortion in the independent clinic setting

ObjectiveTo establish the safety of deep sedation without intubation delivered by a certified registered nurse anesthetist (CRNA) in an independent outpatient abortion setting. Study designWe performed a review of clinic Quality and Patient Safety Reports, a daily-maintained report of complications at time of all dilation and curettage (D&C) and dilation and evacuation (D&E) procedures performed at an independently operated, urban, high-volume abortion clinic between March 2013 and August 2017. The clinic provided procedures through 23 weeks 6 days gestation to women at low risk for medical or surgical complications, referring high-risk procedures to a nearby hospital. A CRNA provided anesthesia for all deep sedation procedures. We extracted information on gestational age, risk factors, and clinical course for all patients who experienced any anesthesia-related complication. ResultsDuring the study period, the clinic evaluated 10,297 women for surgical abortion, referring 292 high-risk cases and performing 10,005 procedures (9004 D&C and 1001 D&E), most (9405 [94%]) with deep sedation. We documented six anesthesia-related complications; three (0.03%) in D&C procedures (laryngospasm not requiring intubation [n = 2] and respiratory stridor) and three (0.30%) in D&E procedures (laryngospasm requiring intubation, seizure, and hypotension/bradycardia). Only one patient (0.01%) required intubation. ConclusionsAnesthesia-related complications in the setting of deep sedation without intubation during surgical abortion were exceedingly rare, supporting the safety of this form of anesthesia for low-risk patients in an independent community clinic setting. ImplicationsIndependent community clinics, where the majority of abortion procedures are performed within the U.S., can provide safe anesthesia care using deep sedation provided by CRNA professionals. This care delivery model, which includes triaging patient eligibility, reassuringly provides anesthesia as safely as other greater resourced care delivery settings.

Eichmann’s Mistake: The Problem of Thoughtlessness in International Criminal Law

Atrocities are often unprecedented and identifying them therefore may require moral and political judgement, not only the application of legal rules. Consequently, potential defendants charged for perpetrating them may be genuinely unable to recognize the law that prohibits their criminal activity. Starting from its classical treatment in Hannah Arendt’s Eichmann in Jerusalem, this problem has perplexed scholars who have noted the seemingly normal character of defendants in mass atrocity cases. In disagreement with other scholars in the area, I argue for a recognition of a “mistake of law”? defense in international criminal law. The Article demonstrates the stakes of the claim through three hypothetical international criminal cases with different political underpinnings, all pertaining to burning contemporary concerns: cases against individuals responsible for the enormous risks of climate change; against abusers of migrants in the context of border enforcement; and against individuals responsible for the termination of pregnancies in abortion clinics. I argue for a dual approach: on the one hand, prosecutors and judges must constantly leave open the possibility of a radical departure from extant doctrine and precedent in charging individuals. On the other, they must recognize that defendants may reasonably not be able to recognize the law qua law, especially when such departures occur. The internal tension between these two imperatives sheds light on the predicament of international criminal adjudication. A recognition of the proposed mistake of law defense is but a modest doctrinal solution for a much more fundamental perplexity of the discipline. Yet it is especially crucial today, with an ever-clearer normative divergence among actors in the “international community.”?

Does distance decrease healthcare options for pregnant, incarcerated people? Mapping the distance between abortion providers and prisons,

ObjectivesPregnant, incarcerated people retain the constitutional right to abortion, but evidence suggests that many cannot access abortion services. State and federal prisons are often located in remote areas and there is a known shortage of abortion providers across the U.S., particularly in remote areas. The goal of this study was to determine the proximity of state and federal prisons to the nearest abortion clinic. Study designWe used publicly available information to identify and geocode abortion clinics in the U.S., as well as state and federal prisons that house at least 10 females. We then determined the shortest distance between each prison and the abortion clinics within that state using the Google distance matrix API. For each state, we identified the minimum distance from a state or federal prison to an abortion clinic. ResultsWe georeferenced 643 abortion clinics, 75 state prisons and 20 federal prisons. The farthest minimum distance between a state prison and abortion clinic was 383 miles; the shortest was 2.2 miles. The farthest minimum distance between a federal prison and abortion clinic was 117 miles; the shortest was 0.49 miles. There were 8 states in which the minimum distance between any prison and an abortion clinic was above 75 miles. ConclusionState and federal prisons are not located in close proximity to abortion clinics. This may pose an additional barrier pregnant incarcerated people face when they need abortion care. ImplicationsDistance between prisons and abortion clinics may contribute to the many barriers that incarcerated people face when seeking an abortion. Policies and laws that exacerbate the burden of distance further impair incarcerated people’s abilities to access abortion and prisons’ constitutional obligation to provide access to abortion.

Sophie's choice: Narratives of ‘saving’ in British public debates on abortion

In the UK, narratives about saved women and babies have been a significant feature in anti-abortion campaigns to oppose bufferzones, which seek to prevent anti-abortion activists from being directly outside abortion clinics. Anti-abortion activists argue that without their presence, the ‘abortion industry’ will fail to seek ‘informed’ consent and coerce women into abortions. These presumptions are based on positioning abortion, and service providers, as inherently ‘evil’, whilst saving is rooted in Christian beliefs aimed at ensuring that souls go to heaven.This paper emerges from ethnographic research in Britain on anti-abortion activism and pro-choice counter-demonstrations. Highlighting the importance of saving in many of the anti-abortion campaigns, it will argue that as they have a different conceptualisations of harm to pro-choice activists, this leads to a lack of understanding of each other's saving narrative. Yet to some extent they both draw on a positioning of women as potentially vulnerable and at risk from the actions of others.

Adoption of no-test and telehealth medication abortion care among independent abortion providers in response to COVID-19

ObjectiveAccess to abortion care in the United States (US) is restricted by numerous logistical and financial barriers, which have been further intensified by the COVID-19 pandemic. We sought to understand the ways in which COVID-19 prompted changes in clinical practices in abortion care among independent abortion clinics. Study designWe surveyed independent US abortion clinics and documented changes in practice regarding the provision of abortion since March 1, 2020. ResultsAmong about 153 independent clinics invited, 100 clinics contributed relevant data and were included in the analytic sample. A total of 87% reported changes in protocols in response to the COVID-19 pandemic. Reported changes included moving to telehealth (phone or video) for follow-up (71%), starting or increasing telehealth for patient consultations and screening (41%), reducing Rh testing (43%) and other tests (42%), and omitting the preabortion ultrasound (15%). A total of 20% reported allowing quick pickup of medication abortion pills, and 4% began mailing medications directly to patients after a telehealth consultation. Clinical practice changes were reported throughout all regions of the US, but facilities in the Northeast (73%) were more likely to report starting or increasing telehealth than facilities in the South (23%, p < .001). ConclusionThe COVID-19 pandemic accelerated use of telehealth among independent abortion clinics, but many clinics, particularly those in the South, have been unable to make these changes. Other practices such as reducing preabortion ultrasounds were less common in all regions despite clinical guidelines and evidence supporting such changes in practice and positive benefits for public health and patient-centered care. ImplicationsThe COVID-19 pandemic has created a window of opportunity to remove barriers to abortion, including expanding telehealth and reducing preabortion tests. Clinics can strive for a culture shift towards simplifying the provision of medication abortion and routinely avoiding preabortion tests and in-person visits. Such changes in practice could have positive benefits for public health and patient-centered care.

Covid-19 Surgical Abortion Restriction Did Not Reduce Visits to Abortion Clinics

Due to COVID-19, 33 states banned elective medical procedures, and 13 of these states included surgical abortions. We collected street addresses of abortion clinics and linked them to SafeGraph's data on counts of visitors. We found a 32 percent decrease in clinics visits in February-May of 2020 compared to 2019. States that banned elective procedures saw an additional 23 percent decrease in visits. However, there was no significant additional decrease in the states that explicitly banned surgical abortions. We estimate that the decrease in foot traffic over these four months reduced abortions by 9 percent in 2020 relative to 2019.

Pop Culture Consolations

Pop Culture Consolations Jane Rosenberg LaForge (bio) Anhedonia Patrick Chapman BlazeVOX Books www.blazevox.org/index.php/Shop/fiction/anhedonia-by-patrick-chapman-526/ 190 Pages; Print, $18.00 Any aficionado of 1970's pop culture knows what "anhedonia" is: it's the title Woody Allen originally wanted for his Oscar-winning 1977 movie Annie Hall. Luckily for the rest of us, the studio bigwigs said no to the use of a psychiatric term to market a funny, if not sad, love story. Most often used to describe a symptom of clinical depression, "anhedonia" denotes the inability to experience joy or pleasure, especially from activities that were once diverting or entertaining. While it might not have been the most appropriate title summing up the romance between Woody Allen and Diane Keaton—or their alter egos—it's more adept for the novella "Anhedonia," in Patrick Chapman's new collection of stories under the same name. It's worth noting that Chapman's Allen-esque references seem to hail from the writer/director's Golden Age, and do not address the morally compromised Allen now in the public eye. What this means for Chapman's work isn't necessarily clear; Chapman's people are, like Allen's characters, selectively self-aware or prone to torture themselves to the point of self-destruction. Women in particular are doomed to grind down all hope of contentment in their present through the sheer force of their miserable pasts. That his men suffer from a similar frustration is a given, and through the bon mots of popular movies and television programs, it's also possible to glean the source of their disregard. Tony Bright is to Allen's Alvy Singer as Dora Potts is to Keaton's Annie Hall in the novella. And the author's use of Allen's preferred appellation to frame Tony and Dora's story is more than homage. The characters watch Annie Hall as their relationship begins to ripen. Everything that ripens also must rot, and so do Tony and Dora as a couple. The reasons seem simple: she wants to settle down; he doesn't. But he can't put his convictions into words that Dora, or anyone else, might understand. If there is any explanation, it's that some people found redemption in their kids but all he could see were the desiccated eyes, the premature baldness, the middleaged spreads. These used-up specimens were the human equivalent of flowers that lose their lustre once they've released their pollen. Tony wants to avoid aging by placing himself above, or outside, the evolutionary imperative. His complaint is not with Dora, or the conventions of coupling, but with the world, fate, and human nature, as it conspires to rid him of his hair and his identifiable waistline. When Dora inadvertently takes the next step in their relationship, it's easy to imagine just how Tony will react. Mourning the love of a woman he once thought unattainable, Tony will later scold himself for sounding like a different Allen alter-ego in another film inspired by Allen and Keaton's history of collaboration and coming apart, Manhattan (1979). At the abortion clinic, where Tony has escorted Dora along the path of least resistance, the counselors and nurses don't understand why Tony is there, how he is necessary to the story: "Tony wished things were different. … Now there was nothing that could be done but accept whatever Dora decided. He had no autonomy here." So Tony does what he is told, a solution Chapman's other male protagonists quickly resort to when finding themselves in similar situations. Doing what he's told is what Jamie does despite his misgivings over a disabled man standing with him at the urinal, in "Eel." Another man daydreams about doing what he's told once he receives a letter from the government announcing his share of the peace dividend, in "The Rocket Curator." And it's what Jeffrey, a business consultant with a chest infection, opts for when the doctor tries to convince him to quit smoking, lose weight, and start exercising. Not that Jeffrey precisely heeds to his doctor's advice. Doing...

The option to look: patient-centred pregnancy tissue viewing at independent abortion clinics in the United States

Abortion providers’ approaches to patient-centred pregnancy tissue viewing (PCV) – when a patient requests to see their products of conception – is understudied in abortion care. This mixed-method study aimed to identify: (1) if, when, and how PCV is facilitated at US independent abortion clinics; (2) how staff are trained to offer viewing; and (3) provider experiences facilitating PCV. We surveyed administrators from 22 independent abortion clinics affiliated with the Abortion Care Network about their PCV practices and then completed in-depth semi-structured interviews with 25 providers to better understand their experiences facilitating PCV. Results indicate that most of the clinics that provide PCV do so by patient request. A variety of providers facilitate viewing, including counsellors, educators, physicians, nurses, and medical assistants. Timing, viewing location, and staff training vary by facility. Benefits of and barriers to PCV emerged through three themes: (1) patient-centred care; (2) misinformation about fetal tissue; and (3) personal navigations as providers. Providers and administrators report PCV aligns with their patient-centred clinic missions and offers patients opportunities for choice, closure, and access to information. Yet, anti-abortion misinformation about fetal tissue impacts the ways providers must navigate complex conversations about PCV professionally and personally. Clinic resources and concern about adverse patient reactions to identifiable fetal parts present barriers to offering viewing. Understanding providers’ experiences and approaches to PCV is an important first step to developing quality practices that can be shared across clinics. The findings of this study support the need for more research and training on PCV in abortion care.

How did the introduction of mifepristone impact the availability of abortion care in Ottawa? A qualitative study with abortion patients

In 2017, mifepristone and misoprostol became available for early pregnancy termination as the combination pack Mifegymiso® in Ottawa, Ontario, Canada. We conducted 40 semi-structured telephone interviews with Ottawa residents who had abortions before mifepristone’s introduction ( n = 20) and after mifepristone–misoprostol became available ( n = 20) to explore their experiences obtaining care. We audio-recorded and transcribed all interviews and analyzed these data for content and themes using deductive and inductive techniques. Prior to the introduction of mifepristone, our participants reported obtaining abortion care at two facilities and many faced long wait times. Those who had an abortion after mifepristone became available reported obtaining care from a wider array of providers and few waited more than two weeks. However, several mifepristone–misoprostol users reported having to go through a process that involved as many as 10 health service encounters. Both groups reflected positively on their abortion experiences, but some patients who obtained mifepristone–misoprostol outside of an abortion clinic did not feel as well informed as they would have liked. The introduction of mifepristone appears to have expanded the number of service delivery points and reduced wait times for those seeking abortion care in Ottawa. Identifying ways to expand access to medication abortion information and streamline services appears warranted.

Expanding access to postpartum long-acting reversible contraception (LARC): how can we deliver?

Unintended pregnancy remains a significant public health challenge in the 21st century. Up to 50% of all pregnancies are thought to be unintended at conception. Due to the rapid return...

Distance Traveled to Obtain Clinical Abortion Care in the United States and Reasons for Clinic Choice.

Introduction: Greater distance to abortion facilities is associated with greater out-of-pocket costs, emergency room follow-up care, negative mental health, and delayed care among U.S. abortion patients. However, the distance U.S. abortion patients travel has not been reported since 2008, and no study has examined reasons abortion patients choose the particular facility where they obtain their abortion.Materials and Methods: We analyzed data from the 2014 Abortion Patient Survey and Abortion Provider Census to report abortion patients' one-way travel from their resident zip code to their abortion clinic, whether they went to the closest clinic, and reasons for facility choice. We report unadjusted and adjusted associations of patients' characteristics with travel distance and differences in average travel distance by abortion patients' reported reasons for choosing their facility.Results: In 2014, 65% of abortion patients traveled less than 25 miles one-way, 17% traveled 25–49 miles, and 18% traveled more than 50 miles. Abortion patients who were white, college-educated, U.S.-born, ≥12 weeks pregnant, and lived outside metropolitan areas were more likely to travel farther. Nearly half of abortion patients went to their nearest provider and 32% chose their facility because it was the closest.Conclusion: These results indicate that travel distance is an important determinant of abortion care access in the United States. Nearly, one-fifth of U.S. abortion patients traveled more than 50 miles one-way and the most common reason reported for clinic choice was that it was the closest.

Using Google Ads to recruit and retain a cohort considering abortion in the United States

ObjectiveThe objective was to develop and test the feasibility of a methodology to recruit and retain individuals in the United States (US) who were considering abortion at the point of searching for an abortion clinic. Study designWe conducted the Google Ads Abortion Access Study, a national cohort study using a novel recruitment method — recruiting people searching for abortion care on Google. Advertisements for the study were displayed in search results. Users who clicked on the advertisement were directed to a landing page explaining the study and then to a screening form. Participants were eligible if they reported being pregnant and considering abortion. They completed an online baseline survey and 4 weeks later were invited by email or text message to complete a follow-up survey. ResultsOver the course of 8 months, we recruited a racially/ethnically and geographically diverse cohort considering an abortion using Google Ads. After removing fraudulent cases, we recruited 1706 respondents, and among these, 1464 (86%) provided contact information for follow-up. Among those providing contact information, 1005 completed the follow-up survey, resulting in a 69% follow-up rate. Older age, white race, higher education, difficulty meeting basic needs, being not religious/spiritual and having no previous births were associated with higher follow-up. Total cost of the ads was $31.99 per completed baseline + follow-up survey. ConclusionResearchers can use online advertising to successfully recruit populations early in their abortion-seeking process to understand the barriers they face and how to improve abortion access. Disadvantages include high cost and a small potential for fraudulent data. ImplicationsGoogle Ads is a feasible tool to recruit and follow a diverse sample of individuals who are considering abortion for studies investigating the barriers they face in obtaining a wanted abortion.

Abortion Providers on Politically Engaging Patients.

For decades, abortion providers have lamented the lack of patients' voices in the abortion rights movement. Given the millions of women who have received abortions, the absence of this large constituency, providers assert, has been politically costly. Underlying this disappointment is a parallel question that reflects a philosophical divide among abortion providers: are attempts to politically engage abortion patients a desired or appropriate element of care? We interviewed providers from 14 abortion clinics, representing a range of approaches to care, patient volume, and geographic locations. We transcribed and analyzed the interviews to identify themes related to whether, why, and how providers worked to politically engage their patients. We found that many respondents limited or avoided political engagement with patients, believing that such efforts interfered with patient care or comfort, were not a priority given limited time, and were not something in which patients were interested. Many participants were unclear as to what political work they could pursue as nonprofit facilities. In contrast, other providers believe political outreach helped patients to more fully understand their care experiences, could influence future patients' access to care, and was an important part of the way they cared for patients. These varying approaches reflect divergent ways of and reasons for engaging abortion patients politically. Future research should consider if the act of obtaining an abortion could be understood as low-level engagement with the abortion rights movement, particularly as abortion access is increasingly limited and patients might be considered potential activists.

Charities call for government review of abortion clinic ‘buffer zones’

A coalition of charities has said it is concerned about the ongoing damage done by anti-abortion protests immediately outside abortion clinics and calls for a review into the decision not to introduce buffer zones to protect women