Abortion In The United States Research Articles

Characteristics and Circumstances of Adolescents Obtaining Abortions in the United States.

The purpose of this study is to describe the sociodemographic and situational circumstances of adolescents obtaining abortion in the United States prior to the Dobbs decision. We use data from the Guttmacher Institute's 2021-2022 Abortion Patient Survey, a cross-sectional survey of 6698 respondents; our analytic sample includes 633 adolescents (<20 years), 2152 young adults (20-24 years), and 3913 adults (25+ years). We conducted bivariate analyses to describe the characteristics and logistical and financial circumstances of adolescents obtaining abortions in comparison to respondents in the other age groups. The majority of adolescents identified as non-white (70%), and 23% identified as something other than heterosexual. We found that 26% of adolescents reported having no health insurance, and two-thirds of adolescent respondents reported that somebody had driven them to the facility. Adolescents differed from adults in their reasons for delays in accessing care; a majority of adolescents (57%) reported not knowing they were pregnant compared to 43% of adults, and nearly one in five adolescents did not know where to obtain the abortion compared to 11% of adults. Adolescents were more likely than adults to obtain a second-trimester abortion, which has increased costs. This study found that this population was more vulnerable than adults on several measures. Findings suggest that adolescents navigate unique barriers with regard to information and logistics to access abortion care.

An estimate of lifetime incidence of abortion in the United States using the 2021–2022 Abortion Patient Survey

ObjectivesThe Guttmacher Institute estimated that, in 2014, 24% of US women of reproductive age would have an abortion by age 45 if the 2014 abortion rate was maintained. This study updates the estimated lifetime incidence of abortion in the year(s) just prior to the Dobbs decision, which removed federal protections for abortion. Study designWe used data from the Guttmacher Institute’s 2021–2022 Abortion Patient Survey and population data for 2020 and 2021 from the Census Bureau, as well as abortion counts from the Guttmacher Institute’s 2020 Abortion Provider Census, to estimate abortion rates, first-abortion rates, and cumulative abortion rates, all by age group. We calculated multiple estimates of lifetime incidence under varying hypothetical conditions as tests of sensitivity. ResultsWe estimate that 24.7% (95% CI: 22.9–26.3) of women aged 15–44 in 2020 would have had an abortion by age 45 if abortion rates in 2020 remain constant. These figures changed slightly when we examined scenarios assuming a 5% increase in abortion between 2020 and 2021 (25.9, 95% CI: 24.0–27.6) and when we adjusted for the potential overrepresentation of adolescent and young adult respondents in the 2021–2022 Abortion Patient Survey (23.9, 95% CI: 22.2–25.6). ConclusionsIn the year(s) prior to the Dobbs decision, one-quarter of US women would have been expected to have at least one abortion in their lifetime if abortion rates for those years stayed the same. ImplicationsSignificant numbers of individuals are being affected by abortion bans, but we are unable to predict how these restrictions will impact abortion incidence or the lifetime incidence in the coming years.

Interest in and Support for Alternative Models of Medication Abortion Provision Among Patients Seeking Abortion in the United States

IntroductionMedication abortion is safe and effective, but restrictions still limit patients from accessing this method. Alternative models of medication abortion provision, namely advance provision, over-the-counter (OTC), and online, could help improve access to care for some, although there is limited evidence about abortion patients’ interest in these models. MethodsBetween 2017 and 2019, we administered a cross-sectional survey to abortion patients at 45 clinics across 15 U.S. states to explore their interest in and support for advance provision, OTC, and online abortion access. We assessed relationships between sociodemographic characteristics and interest in and support for each model using bivariate logistic regressions and present perceived advantages and disadvantages of each model, as described by a subset of participants. ResultsAmong 1,965 people enrolled, 1,759 (90%) initiated the survey. Interest in and support for advance provision was highest (72% and 82%, respectively), followed by OTC (63% and 72%) and online access (57% and 70%). In bivariate analyses, non-Hispanic Black and Asian/Pacific Islander respondents expressed lower interest and support for the online model and Alaska Native/Native American respondents expressed higher interest in an OTC model, as compared with white respondents. Among 439 participants naming advantages and disadvantages of each model, the most common advantages included convenience and having the abortion earlier. The most common disadvantages were not seeing a provider first and possibly taking pills incorrectly. ConclusionsAlthough most abortion patients expressed interest in and support for alternative models of medication abortion provision, variation in support across race/ethnicity highlights a need to ensure that abortion care service models meet the needs and preferences of all patients, particularly people from historically underserved populations.

Provision of Medications for Self-Managed Abortion Before and After the Dobbs v Jackson Women’s Health Organization Decision

The Supreme Court decision in Dobbs v Jackson Women's Health Organization overturned the right to choose abortion in the US, with at least 16 states subsequently implementing abortion bans or 6-week gestational limits. Prior research indicates that in the 6 months following Dobbs, approximately 32 360 fewer abortions were provided within the US formal health care setting. However, trends in the provision of medications for self-managed abortion outside the formal health care setting have not been studied. To determine whether the provision of medications for self-managed abortion outside the formal health care setting increased in the 6 months after Dobbs. Cross-sectional study using data from sources that provided abortion medications outside the formal health care setting to people in the US between March 1 and December 31, 2022, including online telemedicine organizations, community networks, and online vendors. Using a hierarchical bayesian model, we imputed missing values from sources not providing data. We estimated the change in provision of medications for self-managed abortion after the Dobbs decision. We then estimated actual use of these medications by accounting for the possibility that not all provided medications are used by recipients. Abortion restrictions following the Dobbs decision. Provision and use of medications for a self-managed abortion. In the 6-month post-Dobbs period (July 1 to December 31, 2022), the total number of provisions of medications for self-managed abortion increased by 27 838 (95% credible interval [CrI], 26 374-29 175) vs what would have been expected based on pre-Dobbs levels. Excluding imputed data changes the results only slightly (27 145; 95% CrI, 25 747-28 246). Accounting for nonuse of medications, actual self-managed medication abortions increased by an estimated 26 055 (95% CrI, 24 739-27 245) vs what would have been expected had the Dobbs decision not occurred. Provision of medications for self-managed abortions increased in the 6 months following the Dobbs decision. Results suggest that a substantial number of abortion seekers accessed services despite the implementation of state-level bans and restrictions.

US abortion bans should not pre-empt the duty to provide life-saving abortion care to pregnant patients in medical emergencies

US abortion bans should not pre-empt the duty to provide life-saving abortion care to pregnant patients in medical emergencies

Potential consequences of the Dobbs v. Jackson Women's Health Organization decision.

In June 2022, the U.S. Supreme Court released a landmark decision in which they held that the right to abortion is not protected by the U.S. Constitution, ending almost 50 years of federally legal abortion in the United States. Because prior research demonstrates linkages between reproductive health and substance use at multiple socioecological levels, in this special section, we present studies that take a broad scope to understanding how addictive behaviors and reproduction-related behaviors, options, and access to care interrelate across a variety of contexts. In this introduction, the guest editors detail the impetus for this special section, provide a brief overview of the present studies, discuss policy and intervention implications, and suggest future research directions. The five studies presented in this special section span a wide range of populations, methods, and substance use and reproduction-related issues, including reasons for past abortions among women with opioid use disorder, alcohol effects on men's condom use resistance, considerations regarding alcohol-involved rape on implementation of "rape exceptions" to abortion bans, the role of early exposure to substance use and sexual abuse on reproductive health outcomes, and the effects of exposure to abortion-related media coverage on alcohol use intentions following the Supreme Court decision. The studies in this special section highlight the ways in which substance use and reproductive health are inextricably intertwined. Recent and future changes in reproductive health legislation and policy underscore the critical need for continued empirical inquiry into these intersecting public health concerns. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

HOW CULTURE AFFECTS ABORTION LAWS AND ITS IMPACTS

The Supreme Court's role in shaping reproductive rights for women in the United States has been significant since the landmark ruling in Roe v. Wade in 1973. However, the ongoing debate over access to reproductive healthcare and abortion rights persisted, leading to the recent overturning of Roe v. Wade in 2022. This research explores the impact of legislative laws on abortion in the United States, focusing on the Dobbs v. Jackson case and its aftermath. This research discusses how trigger bans and gestational bans have resulted in a rapid decline in access to abortion services, particularly for marginalized communities. It also highlights the impact of these laws on young pregnant girls, who already face limited abortion options due to existing restrictions. This research further examines the role of culture in shaping views on abortion, including religious beliefs, stigma, and geographical location. It concludes by discussing the shift from pro-life to pro-choice views among Americans and the need for increased media coverage and advocacy campaigns to challenge stigma and humanize the abortion experience.

Effectiveness and safety of telehealth medication abortion in the USA

Telehealth abortion has become critical to addressing surges in demand in states where abortion remains legal but evidence on its effectiveness and safety is limited. California Home Abortion by Telehealth (CHAT) is a prospective study that follows pregnant people who obtained medication abortion via telehealth from three virtual clinics operating in 20 states and Washington, DC between April 2021 and January 2022. Individuals were screened using a standardized no-test protocol, primarily relying on their medical history to assess medical eligibility. We assessed effectiveness, defined as complete abortion after 200 mg mifepristone and 1,600 μg misoprostol (or lower) without additional intervention; safety was measured by the absence of serious adverse events. We estimated rates using multivariable logistic regression and multiple imputation to account for missing data. Among 6,034 abortions, 97.7% (95% confidence interval (CI) = 97.2–98.1%) were complete without subsequent known intervention or ongoing pregnancy after the initial treatment. Overall, 99.8% (99.6–99.9%) of abortions were not followed by serious adverse events. In total, 0.25% of patients experienced a serious abortion-related adverse event, 0.16% were treated for an ectopic pregnancy and 1.3% abortions were followed by emergency department visits. There were no differences in effectiveness or safety between synchronous and asynchronous models of care. Telehealth medication abortion is effective, safe and comparable to published rates of in-person medication abortion care.

Abortion in The United States – The Impact of Changing Legislation on Prescription Patterns in Pediatric and Maternal Populations

Background and Hypothesis: Changes in healthcare legislation may have unintended consequences for patient care at the individual level. Following the Supreme Court case Dobbs vs Jackson Women’s Health Organization in 2022 resulting in the reversal of Roe V. Wade, many states enacted new abortion legislation. Currently, there are many restrictions and barriers to abortion and reproductive care that may limit access across the country. Given the volatile political environment surrounding abortion legislation, there may be some confusion among clinicians about the legality of abortion and miscarriage care. Abortion legislation and restriction may have an impact on other areas of healthcare, including prescription patterns of Category X medications in women of childbearing age. Based on the current legislation, we hypothesize that prescription rates of Category X medications will decrease while prescription rates of birth control methods will increase.&#x0D; Project Methods: Real world data on prescribing patterns will be obtained from IUH Cerner database and the Cerner Learning Health Network. Demographic information including age, race and insurance status will be obtained. Data will be analyzed to assess trends in prescription patterns for women of childbearing age that correlate with dates of changing abortion legislation.&#x0D; Potential Impact: The findings from this study will help direct future research on medication prescription and administration in people of childbearing age. Results may also inform future policy changes surrounding women’s healthcare.

Creation Stories: Reproductive Crisis and the “Birth / Abortive” of Science Fiction

ABSTRACT This essay develops a genealogy of feminist science fiction as a revisionary reckoning with the enduring influence of patriarchal creation stories. Situating my reading practice in relation to the Dobbs decision overturning the constitutional right to abortion in the United States, I consider scenes in Paradise Lost, Frankenstein, and Lilith’s Brood in which characters negotiate fraught reproductive choices with acts of speculative story-telling. The allegorical embodiments of reproductive crisis, I argue, are monstrous, inscrutable figures—John Milton’s Chaos, Mary Shelley’s creature, and Octavia Butler’s Oankali-human hybrids—who stand for inherited violence but also the “abortive” potential of reproduction gone awry.

FEMINIST QUEEN OR CONSPIRACY THEORIST? FEMALE SPREADERS OF WOMEN'S HEALTH DISINFORMATION

Soon after the $2 decision overturned the federal right to abortion in the United States, an investigation revealed a disinformation campaign against birth control, driven by anti-abortion influencers. Disinformation targeting abortion and birth control is partially rooted in conspiracy, particularly the Great Replacement Theory, which plays on fears of white people being “replaced” by people of color. This notion is a long-standing issue of the anti-abortion movement, as early successes in banning abortion were partially motivated by fears of white people having fewer babies than people of color. Studies have shown that Black Americans believe in conspiracy theories about birth control, e.g., that it is deployed by the government as a form of genocide against Black people. Unfortunately, though, these beliefs are not entirely unfounded. This problematizes definitions of conspiracy theories as inherently false and unjustified—Black Americans, for instance, have long undergone inhumane experimentation by the American medical system. This illuminates a troubling connection—that between embodied oppression and conspiracy-believing. We query whether this overlap is weaponized by the anti-abortion community to spread disinformation campaigns. Through a critical technocultural discourse analysis of 14 hours of Instagram stories and posts from 154 members of the anti-abortion collected between February 14, 2023 and February 27, 2023, we find that the anti-abortion movement has weaponized feminist knowledge-production and relies on grains of embodied experience to spread disinformation campaigns, which at times snowball into racially-motivated conspiracy theories for political and/or financial gain.

Medication Abortion and Abortion Pill Reversal: An Exploratory Analysis on the Influence of Others in Women's Decision-Making.

Introduction As medication abortion accounts for a growing share of abortions in the United States, an increasing number of women are seeking abortion pill reversal (APR). These decisions are typically not made in isolation. However, little research exists on women's APR decision-making and the role played by people close to them. Methods We surveyed women who contacted a national hotline for information on APR and who completed a two-week treatment protocol with progesterone (n = 67). We analyzed women's open-ended answers using thematic analysis to identify memorable messages about medication abortion and APR. Participants' communication with other people in their lives was assessed using the Isolation subscale of the Individual Level Abortion Stigma (ILAS) scale, and decision-making difficulty was assessed using a Likert scale. Results Thirty-six respondents met the eligibility criteria and filled out the ILAS and decision-difficulty scales. Women tended to talk with family and friends about their medication abortion decisions, while they typically sought information online when deciding about APR. Women reported greater stigma in their disclosures about their abortions than in their disclosures about APR (p = 0.006). Conclusion Memorable messages influence women's decisions to pursue medication abortion and APR.

Roe : Telling the Tale

Abstract: This essay details Berkman's efforts to grapple with the recent Dobbs v. Jackson Women's Health Organization , recriminalizing abortion in the United States. She discusses the history of reproductive justice in the US, including revealing the far more complicated history of religion and abortion than was usually assumed, and highlights the complications that will arise now that Roe v. Wade has been officially overturned.

Incarceration Status Among Individuals Obtaining Abortion in the United States, 2020.

Objectives. To examine the abortion frequency among incarcerated people before Dobbs v Jackson Women's Health Organization was decided. Methods. We used data from the 2020 Abortion Provider Census to examine the number and distribution of facilities that provided abortions to incarcerated patients. Results. Sixty-seven clinics across 25 states and the District of Columbia provided more than 300 abortions to incarcerated patients in 2020. Eleven of these clinics are in states that now have total or near-total abortion bans. Public Health Implications. People in jails and prisons face many structural barriers when seeking an abortion, especially with increased state abortion restrictions and an inability to travel out of state. If they cannot obtain desired care, people may be forced to continue pregnancies in harsh conditions. To address abortion access inequities, policy and research must consider incarcerated individuals. (Am J Public Health. 2023;113(12):1352-1355. https://doi.org/10.2105/AJPH.2023.307411).

The Role of Telehealth in Promoting Equitable Abortion Access in the United States: Spatial Analysis.

Even preceding the Supreme Court's 2022 Dobbs v. Jackson Women's Health Organization decision, patients in the United States faced exceptional barriers to reach abortion providers. Abortion restrictions disproportionately limited abortion access among people of color, young people, and those living on low incomes. Presently, clinics in states where abortion remains legal are experiencing an influx of out-of-state patients and wait times for in-person appointments are increasing. Direct-to-patient telehealth for abortion care has expanded since its introduction in the United States in 2020. However, the role of this telehealth model in addressing geographic barriers to and inequities in abortion access remains unclear. We sought to examine the amount of travel that patients averted by using telehealth for abortion care, and the role of telehealth in mitigating inequities in abortion access by race or ethnicity, age, pregnancy duration, socioeconomic status, rural residence, and distance to a facility. We used geospatial analyses and data from patients in the California Home Abortion by Telehealth Study, residing in 31 states and Washington DC, who obtained telehealth abortion care at 1 of 3 virtual abortion clinics. We used patients' residential ZIP code data and data from US abortion facility locations to document the round-trip driving distance in miles, driving time, and public transit time to the nearest abortion facility that patients averted by using telehealth abortion services from April 2021 to January 2022, before the Dobbs decision. We used binomial regression to assess whether patients reported that telehealth was more likely to make it possible to access a timely abortion among patients of color, those experiencing food insecurity, younger patients, those with longer pregnancy durations, rural patients, and those residing further from their closest abortion facility. The 6027 patients averted a median of 10 (IQR 5-26) miles and 25 (IQR 14-46) minutes of round-trip driving, and 1 hour 25 minutes (IQR 46 minutes to 2 hours 30 minutes) of round-trip public transit time. Among a subsample of 1586 patients surveyed, 43% (n=683) reported that telehealth made it possible to obtain timely abortion care. Telehealth was most likely to make it possible to have a timely abortion for younger patients (prevalence ratio [PR] 1.4, 95% CI 1.2-1.6) for patients younger than 25 years of age compared to those 35 years of age or older), rural patients (PR 1.4, 95% CI 1.2-1.6), those experiencing food insecurity (PR 1.3, 95% CI 1.1-1.4), and those who averted over 100 miles of driving to their closest abortion facility (PR 1.6, 95% CI 1.3-1.9). These findings support the role of telehealth in reducing abortion-related travel barriers in states where abortion remains legal, especially among patient populations who already face structural barriers to abortion care. Restrictions on telehealth abortion threaten health equity.

Rethinking the Right to Abortion in the United States of America

Američki je Vrhovni sud u predmetu Dobbs v. Jackson Women’s Health Organization (2022.) odbacio najvažnije dijelove svojih prijašnjih odluka o pobačaju te, može se slobodno reći, preusmjerio dosadašnji razvoj prava na pobačaj. Premda Dobbs nije priznao pravo fetusa na život, većina je sudaca odlučila da pobačaj nije temeljno ustavno pravo, nego spada u domenu “zdravstvenih i socijalnih propisa” te da se zakoni koji ga uređuju mogu ustavno propitivati samo prema tomu jesu li “racionalno povezani s legitimnim državnim interesom”. Rad je podijeljen u pet glavnih dijelova. U prvom se ukratko ukazuje na temeljna pitanja u suvremenim zakonodavnim raspravama o pobačaju. Drugi dio kritički izlaže glavne argumente iznesene u presudi Roe v. Wade (1973.), a treći to čini za odluku Planned Parenthood v. Casey (1992.). Četvrti dio istražuje tektonski preokret do kojega je došlo nakon odluke Vrhovnoga suda u predmetu Dobbs te peti dio iznosi predviđanja što slijedi nakon te odluke.

Telemedicine Abortion.

Telemedicine has become a substantial part of abortion care in recent years. In this review, we discuss the history and regulatory landscape of telemedicine for medication abortion in the United States, different models of care for telemedicine, and the safety and effectiveness of medication abortion via telemedicine, including using history-based screening protocols for medication abortion without ultrasound. We also explore the acceptability of telemedicine for patients and their perspectives on its benefits, as well as the use of telemedicine for other parts of abortion care. Telemedicine has expanded access to abortion for many, although there remain limitations to its implementation.

Emotional, informational, and decision-making support needs among people seeking abortion in the US: perspectives from All-Options Talkline callers

People seeking abortion may need or want emotional or informational support before, during, and after their abortion. Feeling supported and affirmed contributes to perceptions of quality care. The All-Options Talkline offers free, telephone-based, peer counselling to callers anywhere in the United States. This study aimed to explore the types of support received through the Talkline and the ways it supplemented other forms of support received by people who obtained an abortion. Between May 2021 and February 2022, we conducted 30 interviews via telephone or Zoom with callers recruited through the Talkline. We coded the interviews and conducted thematic analysis, focusing on themes related to gaps of support from family, friends, and healthcare professionals, as well as types of support received through the Talkline. We identified four key motivations for calling the Talkline, including the need for (1) decision-making support and validation, (2) a neutral perspective, (3) emotional support to discuss negative or complex feelings, and (4) information about the abortion process. Participants indicated that interactions with family, friends, and healthcare professionals ranged from unsupportive and negative, to substantially supportive. Access to the Talkline was particularly useful prior to clinical interactions and in the weeks or months after an abortion. We found that the All-Options Talkline provided person-centred, remote support for callers, filling gaps or supplementing support from one's community or healthcare professionals. Abortion support from non-medically trained support people contributes to high-quality abortion care, especially in a time of increasing abortion restrictions and use of remote abortion services.

Self-managed Medication Abortion in the United States.

Self-managed abortion (SMA) is ending a pregnancy without medical supervision, either by obtaining medications (known as self-managed medication abortion) or through other means. Many factors influence a person's decision to pursue self-managed abortion, such as time constraints, financial considerations, and local availability of abortion services. We present on the prevalence, methods and best practices for clinicians in the United States who may interface with individuals undergoing self-managed medication abortion at any point in the process through a harm reduction approach.

“Technically an abortion”: Understanding perceptions and definitions of abortion in the United States

Anti-abortion legislation in the United States exploits misinformation and ignores medical definitions to curtail access to essential healthcare. Little is known about how individuals most likely to need this care define abortion, in general or as distinct from miscarriage, and how this might impact access to, utilization of, and experiences of care. Using mixed-method card sort and vignette data from cognitive interviews (n = 64) and a national online survey (n = 2009), we examined individuals’ understandings of pregnancy outcomes including abortion and miscarriage.Our findings show that people hold varying ideas of what constitutes an abortion. Many respondents considered ‘intent’ when classifying pregnancy outcomes and focused on intervention to distinguish between miscarriages and abortions. Particularly, medical intervention was found as a defining feature of abortion. Lack of knowledge regarding pregnancy experiences and ambiguity surrounding early stages of pregnancy also influenced respondents' understanding of abortion.We find that abortion and miscarriage definitions are socially constructed and multi-layered. Advancing our understanding of abortion and miscarriage definitions improves reproductive health research by elucidating potential areas of confusion that may lead to misreporting of reproductive experiences as well as highlighting ways that blurred definitions may be exploited by abortion opponents.