Abortion In California Research Articles

Willingness of Pharmacists to Prescribe Medication Abortion in California

Nearly half of US states have restricted abortion access. Policy makers are exploring pathways to increase access to abortion and reproductive health care more broadly. Since 2016, California pharmacists could prescribe hormonal birth control, providing an opportunity to learn about the implementation of pharmacist-provided reproductive health care. To explore the feasibility of broadening pharmacist scope of practice to include prescribing medication abortion. A cross-sectional online survey was conducted from October 11 to December 20, 2022, among a convenience sample of California licensed community pharmacists to examine their attitudes toward, knowledge of, and confidence in prescribing hormonal birth control and reports of pharmacy-level practices. Descriptive analyses and log-binomial regression models were used to compare medication abortion and contraceptive provision attitudes by pharmacist and pharmacy characteristics. Among the 316 pharmacists included in the analysis who worked at community pharmacies across California (mean [SD] age, 40.9 [12.0] years; 169 of 285 [59.3%] cisgender women; and 159 of 272 [58.5%] non-Hispanic Asian individuals), most (193 of 280 [68.9%]) indicated willingness to prescribe medication abortion to pharmacy clients if allowed by law. However, less than half were confident in their knowledge of medication abortion (139 of 288 [48.3%]) or their ability to prescribe it (115 of 285 [40.4%]). Pharmacists who indicated that providing access to hormonal birth control as a prescribing provider was important (263 of 289 [91.0%]) and were confident in their ability to prescribe it (207 of 290 [71.4%]) were 3.96 (95% CI, 1.80-8.73) times and 2.44 (95% CI, 1.56-3.82) times more likely to be willing to prescribe medication abortion and to express confidence in doing so, respectively. Although most pharmacists held favorable attitudes toward hormonal birth control, less than half (144 of 308 [46.8%]) worked in a pharmacy that provided prescriptions for hormonal birth control, and 149 who did not reported barriers such as lack of knowledge or training (65 [43.6%]), insufficient staff or time to add new services (58 [38.9%]), and lack of coverage for services (50 [33.6%]). The findings of this cross-sectional survey study of California pharmacists suggest that most pharmacists were willing to prescribe medication abortion. However, future efforts to expand pharmacists' scope of practice should include training to increase knowledge and confidence in prescribing medication abortion. Pharmacy-level barriers to hormonal birth control prescription, such as insurance coverage for pharmacist effort, should also be addressed, as they may serve as barriers to medication abortion access.

Traveling to California from out of state to receive abortion services at a hospital-based clinic: A qualitative study of people’s experiences

ObjectivePeople seeking abortion care in the Western United States face unique challenges. We conducted a qualitative study among people who traveled to California from out of state to receive abortion services, with the aim of characterizing the interplay of motivators, costs, and facilitators to accessing abortion in this region. MethodsWe recruited English-speaking people residing outside of California who accessed care at an urban abortion clinic in San Francisco between October 2017 and May 2018. Interested participants completed a brief demographic survey and in depth semi-structured telephone interview. We relied on grounded theory methods to perform thematic analysis and stopped recruitment upon reaching thematic saturation. ResultsWe conducted 18 in-depth interviews. People mostly had to travel to California for abortion due to local clinic gestational age limits, medical necessity, and to reduce cost. Participants also lamented that travel necessitated unwanted disclosure of their abortion, however this disclosure enabled them to get the logistical support needed for travel. People mostly relied on their networks of family and friends to facilitate these logistics. ConclusionsThis study highlights the interplay of motivators, costs, and facilitators people who travel to California from nearby states face when seeking abortion services. ImplicationsWe position the concept of ‘unwanted disclosure’ as both an emotional cost and an operator that often served to enable people to get the support (logistical, financial, professional) they needed to actualize their abortion in California. These people may benefit from additional financial and social support services in order to actualize their abortion.

Review: From Back Alley to the Border: Criminal Abortion in California, 1920–1969, by Alicia Gutierrez-Romine

Alicia Gutierrez-Romine’s From Back Alley to the Border might have been better titled “From Back Alley to Relatively Safe Abortion Mill to Border.” Or at least that title would have reflected the book’s argument, even if it is less snappy. Truly, this book centers on the sites and safety of illegal abortion provisions in California before 1969. Gutierrez-Romine argues that before the 1930s, women sought abortions from a variety of practitioners with a broad spectrum of experience and credentials. At this point, more women died from the procedure because the law had created a black market without a regulated product and because the procedure was relatively easy to botch. The first four chapters of the book cover various types of abortion providers, how the media represented them and how the law punished them unequally, depending on race, gender, and professional status.Gutierrez-Romine gets to the meat of her story beginning in Chapter 5 on the Pacific Coast Abortion Ring (PCAR), an extensive abortion syndicate that linked doctors up and down the coast beginning in 1934. The PCAR was the brainchild of Reginald Rankin, a Southern California doctor, who joined forces with Seattle doctor George Watts. Watts had pioneered the vacuum aspiration technique, making abortions much safer. Together they trained and recruited a host of abortionists. Some of the syndicate’s procedures—like moving providers frequently—made abortions safer for the abortionists, and Watt’s medical innovation made the procedure safer for patients. Because of decreased mortality from illegal abortion, there were more women to testify against the PCAR when its members were eventually prosecuted.The U.S.-Mexico border appears in the book’s last chapter. By 1953, Rankin’s two stays in prison had motivated him to innovate once more. He continued to find clients in California but moved the medical part of his practice to Tijuana. This move across an international border helped him escape additional conviction. Gutierrez-Romine argues that in the 1950s and 1960s, Mexico became “a beacon and a specter,” symbolizing the possibilities and perils of illegal abortion (p. 174). Eventually, doctors in California used the assumed danger of the Tijuana abortion to argue that they were preserving the lives of women by providing abortions in California. In the resulting case, People of the State of California v. Belous (1969), the court found California’s abortion law was “void for vagueness,” decriminalizing abortion in the state.Through her attention to California, Gutierrez-Romine adds to the history of illegal abortion in the twentieth century; Leslie Reagan’s eastern- and midwestern-focused When Abortion Was a Crime (1997) remains an essential read. Gutierrez-Romine’s story of the PCAR offers fascinating insight into an elaborate crime syndicate that also provided women with an essential medical procedure. Additionally, the final chapter on abortion tourism to Mexico helps shed new light on the state’s important abortion liberalization campaign. Popular culture has kept the “back alley” in our collective historical memory. Gutierrez-Romine suggests that the relatively safe illegal abortion mill and the cross-border abortion should be there too. Hopefully all three can remain in our past.

Review: From Back Alley to the Border: Criminal Abortion in California, 1920–1969, by Alicia Gutierrez-Romine

Review: <i>From Back Alley to the Border: Criminal Abortion in California, 1920–1969</i>, by Alicia Gutierrez-Romine

Time from first clinical contact to abortion in Texas and California

Objective:To assess whether having an abortion in Texas, a U.S. state with many restrictive abortion laws, is associated with increased time between contacting an abortion provider and receiving an abortion, compared to having an abortion in California, a less restrictive U.S. state.Methods:This is a multisite, cross-sectional survey of 434 patients in 12 abortion facilities (ambulatory surgical centers and clinics) in Texas (n = 291) and three abortion clinics in California (n = 143) from 2018 to 2019. At 11 facilities in Texas the response rate was 76%. The response rate was not collected at other sites. We compare the clinical-contact-to-abortion time interval between the facilities in these two states using mixed-effects multivariable logistic regression, adjusting for age, race, education, household income, parity, marital status, and insurance status. We also compare barriers to scheduling and traveling to abortion appointments.Results:Median clinical-contact-to-abortion time is similar among respondents in Texas and California [(9 vs 8 days, p = 0.86). The odds of having a clinical-contact-to-abortion time ≥7 days is similar among respondents in Texas compared to California (adjusted odds ratio 1.0 (95% confidence interval, 0.4–2.6, p = 0.98). Respondents in Texas travel farther for their abortion (mean 22.1 vs 13.5 miles, p < 0.01), are more likely to sell something of value or delay paying another expense to pay for their abortion (49.7% vs 11.4%, p < 0.01), and to miss work to attend their abortion (73.9% vs 61.3%, p = 0.03).Conclusions:In this study, we found no difference in clinical-contact-to-abortion time between respondents in Texas and those in California. Respondents in Texas, however, face other significant barriers in obtaining abortion care, which result in life disruptions and financial hardship.

Alicia Gutierrez-Romine, From Back Alley to the Border: Criminal Abortion in California, 1920-1969

Alicia Gutierrez-Romine, From Back Alley to the Border: Criminal Abortion in California, 1920-1969

Distance traveled for Medicaid-covered abortion care in California

BackgroundAccess to abortion care in the United States is limited by the availability of abortion providers and their geographic distribution. We aimed to assess how far women travel for Medicaid-funded abortion in California and identify disparities in access to abortion care.MethodsWe obtained data on all abortions reimbursed by the fee-for-service California state Medicaid program (Medi-Cal) in 2011 and 2012 and examined distance traveled to obtain abortion care by several demographic and abortion-related factors. Mixed-effects multivariable logistic regression models were constructed to examine factors associated with traveling 50 miles or more. County-level t-tests and linear regressions were conducted to examine the effects of a Medi-Cal abortion provider in a county on overall and urban/rural differences in utilization.Results11.9% (95% CI: 11.5–12.2%) of women traveled 50 miles or more. Women obtaining second trimester or later abortions (21.7%), women obtaining abortions at hospitals (19.9%), and rural women (51.0%) were most likely to travel 50 miles or more. Across the state, 28 counties, home to 10% of eligible women, did not have a facility routinely providing Medi-Cal-covered abortions.ConclusionsEfforts are needed to expand the number of abortion providers that accept Medi-Cal. This could be accomplished by increasing Medi-Cal reimbursement rates, increasing the types of providers who can provide abortions, and expanding the use of telemedicine. If national trends in declining unintended pregnancy and abortion rates continue, careful attention should be paid to ensure that reduced demand does not lead to greater disparities in geographic and financial access to abortion care by ensuring that providers accepting Medicaid payment are available and widely distributed.

Genome Report: Identification and Validation of Antigenic Proteins from Pajaroellobacter abortibovis Using De Novo Genome Sequence Assembly and Reverse Vaccinology.

Epizootic bovine abortion (EBA), or “foothill abortion,” is the leading cause of beef cattle abortion in California and has also been reported in Nevada and Oregon. In the 1970s, the soft-shelled tick Ornithodoros coriaceus, or “pajaroello tick,” was confirmed as the disease-transmitting vector. In 2005, a novel Deltaproteobacterium was discovered as the etiologic agent of EBA (aoEBA), recently named Pajaroellobacter abortibovis. This organism cannot be grown in culture using traditional microbiological techniques; it can only be grown in experimentally-infected severe combined immunodeficient (SCID) mice. The objectives of this study were to perform a de novo genome assembly for P. abortibovis and identify and validate potential antigenic proteins as candidates for future recombinant vaccine development. DNA and RNA were extracted from spleen tissue collected from experimentally-infected SCID mice following exposure to P. abortibovis. This combination of mouse and bacterial DNA was sequenced and aligned to the mouse genome. Mouse sequences were subtracted from the sequence pool and the remaining sequences were de novo assembled at 50x coverage into a 1.82 Mbp complete closed circular Deltaproteobacterial genome containing 2250 putative protein-coding sequences. Phylogenetic analysis of P. abortibovis predicts that this bacterium is most closely related to the organisms of the order Myxococcales, referred to as Myxobacteria. In silico prediction of vaccine candidates was performed using a reverse vaccinology approach resulting in the identification and ranking of the top 10 candidate proteins that are likely to be antigenic. Immunologic testing of these candidate proteins confirmed antigenicity of seven of the nine expressed protein candidates using serum from P. abortibovis immunized mice.

Implications of dispensing self-administered hormonal contraceptives in a 1-year supply: a California case study

On September 23, 2016, California became the sixth state to pass legislation requiring health plans and insurers to cover a 12-month supply of FDA-approved self-administered hormonal contraceptives such as contraceptive pills, patches and vaginal rings. This legislation is estimated to result in 38% of current contraceptive pill, patch, and ring users receiving a 12-month supply dispensed at one time. This shift in dispensing patterns was estimated to result in a reduction of 15,000 unintended pregnancies; 2000 fewer miscarriages; and 7000 fewer abortions in California decreasing total net health care expenditures by 0.03%. With similar legislation introduced in 17 states, the findings from this study are important for consideration outside of California.

Sex and the ballot box: perception of ballot measures regarding same-sex marriage and abortion in California

AbstractVoters in many American states have considered important social policies that redefine civil liberties within their state through the initiative and referendum. An important question remaining is, are voters knowledgeable enough to make decisions on these social policies that have far-reaching effects? The common wisdom is that voters rely on information shortcuts in lieu of extensive knowledge about the issues. Unlike candidate elections, however, ballot measures lack some prominent and useful information shortcuts (i.e. party identification). We test the hypothesis that voters use shortcuts to inform their decisions on two ballot measures central to today's policy debates: California's Proposition 4 on parental notification for abortion and Proposition 8 on same-sex marriage. We show that voters do not use cues universally, and, furthermore, factual information has a limited effect on voters’ decisions. In particular, we find that the persuasiveness of an endorsement is conditional on whether an individual trusts the source.

Safety of Aspiration Abortion Performed by Nurse Practitioners, Certified Nurse Midwives, and Physician Assistants Under a California Legal Waiver

We examined the impact on patient safety if nurse practitioners (NPs), certified nurse midwives (CNMs), and physician assistants (PAs) were permitted to provide aspiration abortions in California. In a prospective, observational study, we evaluated the outcomes of 11 487 early aspiration abortions completed by physicians (n = 5812) and newly trained NPs, CNMs, and PAs (n = 5675) from 4 Planned Parenthood affiliates and Kaiser Permanente of Northern California, by using a noninferiority design with a predetermined acceptable risk difference of 2%. All complications up to 4 weeks after the abortion were included. Of the 11 487 aspiration abortions analyzed, 1.3% (n = 152) resulted in a complication: 1.8% for NP-, CNM-, and PA-performed aspirations and 0.9% for physician-performed aspirations. The unadjusted risk difference for total complications between NP-CNM-PA and physician groups was 0.87 (95% confidence interval [CI] = 0.45, 1.29) and 0.83 (95% CI = 0.33, 1.33) in a propensity score-matched sample. Abortion complications were clinically equivalent between newly trained NPs, CNMs, and PAs and physicians, supporting the adoption of policies to allow these providers to perform early aspirations to expand access to abortion care.

Mexican Women Seeking Safe Abortion Services in San Diego, California

Except for in Mexico City, abortion is legally restricted throughout Mexico, and unsafe abortion is prevalent. We surveyed 1,516 women seeking abortions in San Diego, California. Of these, 87 women (5.7%) self-identified as Mexican residents. We performed in-depth interviews with 17 of these women about their experiences seeking abortions in California. The Mexican women interviewed were generally well-educated and lived near the U.S.–Mexican border; most sought care in the United States due to mistrust of services in Mexico, and the desire to access mifepristone, a drug registered in the United States for early medical abortion. Several reported difficulties obtaining health care in Mexico or reentering the United States when they had postabortion complications. Several areas for improvement were identified, including outreach to clinics in Mexico.

Dairy cattle abortion in California: evaluation of diagnostic laboratory data.

A descriptive study was undertaken on 595 dairy cattle abortion submissions to the California Veterinary Diagnostic Laboratory System from July 1, 1987, to December 31, 1989, to determine the etiologic nature and distribution (seasonal and geographical) of dairy cattle abortion in California as reflected by laboratory submissions. Univariate analysis was performed to characterize abortion-related submissions by farm and laboratory variables, and logistic regression analysis was performed to determine factors that may influence success of abortion diagnosis in the laboratory. The proportions of dairies that submitted abortion-related specimens from northern, central, and southern milksheds during the 2.5-year period were 20.3%, 15.7%, and 13.1%, respectively, and 60% of submissions were from medium-sized (200-999 cows) dairies. Submissions consisted of fetus (58%), placenta (2%), fetus and placenta (12%), and fetus, placenta, and maternal blood (0.84%); fetal tissues and uterine fluid constituted the rest. An apparent pattern in abortion submissions was indicated by a peak in submissions during the winter and summer of 1988 and 1989. Infectious agents were associated with 37.1% of submissions; noninfectious causes, 5.5%, and undetermined etiology, 57.3%. Bacterial abortion accounted for 18% of etiologic diagnoses; protozoal, 14.6%; viral, 3.2%; and fungal, 1.3%. Submissions comprising fetus, placenta, maternal blood, or their combinations were associated with a higher likelihood of definitive diagnosis for abortion than tissues, as were fresher specimens and submissions associated with the second trimester of fetal gestation.

Office abortion services for women: private physician providers.

Research suggests that private physician providers of office abortions and the women who seek their services are not included in nationwide surveys of abortion statistics. This study describes the demographic characteristics of private physicians and the prevalence of abortions performed in their offices in Los Angeles County, California, a state in which office abortions are prohibited by law. Factors that influence physicians' decisions to provide the service, as well as the age and ethnicity of the office abortion recipients, are examined. Of 1,004 California Medical Association members who practiced obstetrics and gynecology in Los Angeles County during 1990, 49% returned anonymous, confidential surveys. Seventy percent of physicians had performed at least one abortion in California, and 29% were currently providing this service in their offices. Physician gender, age, ethnicity, and religion were associated with performing abortions. The average abortion patient was not young and ethnic, but White, middle-class, and in her mid- to late twenties. The implications of these findings are discussed.

The molecular epidemiology of equine herpesvirus 1 (equine abortion virus) in Australasia 1975 to 1989.

The restriction endonuclease DNA fingerprints of 57 isolates of equine herpesvirus 1 (EHV1; equine abortion virus) from abortion, perinatal foal mortalities and encephalitis from 15 epidemics that occurred in Australasia between 1975 and 1989 were examined using the enzymes Bam HI, EcoRI and Bgl II. There was a remarkable degree of uniformity in the restriction patterns; mobility differences were observed in only 14 of 52 (27%) of the fragments. Twelve of these 14 fragments were located within the repeat structures that bracket the unique short region of the genome or were located at the left terminus of the 150 kilobase pair genome. Based on the Bam HI fingerprints the commonest virus identified in our study was EHV1.IP (P is for prototype strain). There was a single notable exception in that the Bam HI fingerprints of all 8 isolates from one of 3 Victorian farms that experienced abortion in 1989 resembled a variant EHV1.IB that was identified as a cause of abortion in Central Kentucky in 1970 to 1974. We present evidence that EHV1.IB caused abortion in California in 1964 and has remained unaltered in its Bam HI restriction pattern. No antigenic differences were found among 4 distantly related EHV1 isolates, including the variant IB, using a panel of 5 monoclonal antibodies to glycoprotein C (gC), a glycoprotein recognised to be highly variable. The uniformity of these unrelated EHV1 isolates is further evidence for a recent origin for EHV1 and may help to explain the natural history of this virus in the horse in which it seems to be a cause of serious epidemics of abortion and perinatal mortality, and less commonly of encephalitis.

Abortion as a Medical Career Choice: Entrepreneurs, Community Physicians, and Others

This is a study of physicians in Los Angeles who made the performance of abortions a major or sole component of their practice in the five years (1967-72) subsequent to the legalization of abortion in California. A semistructured interview was used to obtain data on the attitudes, values, and experiences of 42 such physicians. Four distinct career patterns (entrepreneurs, academics, workers, and community physicians) were found. As expected, the physicians tended to be specialists in OB-GYN, concerned about financial rewards, and influenced by past observation of negative consequences of illegal abortions. The major finding is the existence of a subgroup of physicians whose primary identity is businessman or entrepreneur; these fit into the pattern of outsider entrepreneurs. Elements of this pattern were also found among other types of physicians to varying degrees. There is a need to recognize entrepreneurial elements as part of the conceptualization of physicians and other professionals.

Predicting contraceptive use in postabortion patients.

The performance of legal therapeutic abortions in California is now a medical and legal reality. The relative availability of abortion appears to have solved many problems, but has given rise to some unique, new situations such as the person who becomes an abortion repeater because of failure to utilize a method of contraception. In a recent review of the literature, it appears that no research has dealt specifically with this problem. The authors of this study feel that if the person who is unlikely to use contraception can be identified prior to her abortion, the teaching methods, counseling, and prescribing for these patients might be substantially modified to meet this challenge. This study deals with this identification and briefly discusses some suggested interventions with persons identified as probably poor contraceptive users after an abortion. The authors do not wish their views to be construed as meaning that a contraceptive method should be forced on anyone; however, it has been our experience in counseling well over 2000 abortion patients in the last 4 years that the

The Effects of Legal Abortion on Legitimate and Illegitimate Birth Rates: The California Experience

The availability of legal abortion in California appeared to affect California fertility in 1971 with a downward trend in both legitimate and illegitimate births. In 1972 legitimate birth rates continued to fall as rapidly as in 1971 but illegitimacy rates declined less rapidly. Unmarried women continued to be the dominant recipients of legal abortion. Illegitimacy remained at a high level, however, and its rise among white teenagers pointed to the phenomena of women deliberately electing unwed motherhood.

Counseling and Referral for Legal Abortion in California's Bay Area

Counseling and Referral for Legal Abortion in California's Bay Area

Therapeutic abortions in California: First year's experience under new legislation

At the time of this report, over 5,000 abortions will have been performed under California's new abortion law, which became effective November, 1967. The law permits abortion under two general provisions: (1) when “there is substantial risk that continuance of the pregnancy would gravely impair the physical or mental health of the mother”; and (2) when “the pregnancy resulted from rape or incest.” Of all applications submitted for abortion 91 per cent were approved. Not surprisingly, more than 88 per cent of the abortions were done under the mental health provision of the law. The ages of the patients ranged from 12 to 46 years, with 29 per cent being under 20 and 26 per cent 30 and over. Nearly 90 per cent of the women were white and 10 per cent were nonwhite; this ratio closely approximates the color distribution of the general population. Although there is no residency requirement in the law, less than 2 per cent of the total patients were out-of-state residents. Over 50 per cent of the abortions were performed on women who had never been married, while only 11 per cent of the state's live births are to unmarried women. Using the number of legal abortions per 1,000 live births as a means of comparison, there are marked geographic differences in the experience of various areas of the state. There is no way of determining what proportion of mothers having therapeutic abortions would have received illegal abortions if the new legislation were not in effect. However, it is estimated that 20,000 to 100,000 California residents seek illegal abortions yearly. If the smaller figure is close to reality, a fair proportion of women who might have sought illegal abortions may now be obtaining care through the provisions of the new abortion act.