Abortion Policy Research Articles

Abortion Travel Within the United States: An Analysis of Cross-State Movement to Obtain Abortion Care in 2018

Background: In the United States, pregnant people seeking an abortion often travel in order to access care. Abortion access is often more limited for people who live in states with few abortion facilities and restrictive abortion legislation. Methods: We computed state-specific abortion rate (number of abortions per thousand women ages 15-44) with CDC 2018 Abortion Surveillance data and Census data. We calculated percentage of abortion patients leaving their state of residence for abortion care for each state using the CDC’s 2018 Abortion Surveillance data. We categorized percent leaving by policy restrictiveness using NARAL’s classification of restrictiveness of state abortion laws. We categorized percent leaving by “facility density” (number of abortion facilities per million women ages 15-44), calculated using Census data and ANSIRH’s Abortion Facility Database. We created a map of percent leaving by state and a scatterplot of percent leaving against facility density. Thirty-nine states with high quality data are included in our analysis. Findings: In 2018, an average of 8% of US patients left their state of residence for abortion care. Percent leaving varied widely by state: 59% left South Carolina, 53% South Dakota, 46% Mississippi, and 42% Kentucky, while 5% or fewer of patients left from 16 of the states we evaluated. States with more restrictive laws averaged 9% of patients leaving, while states with less restrictive or more protective laws averaged 4% of patients leaving. States in the bottom quartile for facility density averaged 32% leaving, while states in the top quartile averaged 2% leaving. Interpretation: Many patients travel across state lines for abortion care. Restrictive state-level abortion policy and facility scarcity may play a role in patients leaving their state of residence. Funding: This study was supported by a philanthropic foundation that makes grants anonymously. Funding: This study was supported by a philanthropic foundation that makes grants anonymously. The Declaration of Interest: The authors have no conflicts of interest to report.

How the coronavirus disease 2019 pandemic is impacting sexual and reproductive health and rights and response: Results from a global survey of providers, researchers, and policy-makers.

IntroductionWe aimed to give a global overview of trends in access to sexual and reproductive health and rights (SRHR) during the coronavirus disease 2019 (COVID‐19) pandemic and what is being done to mitigate its impact.Material and methodsWe performed a descriptive analysis and content analysis based on an online survey among clinicians, researchers, and organizations. Our data were extracted from multiple‐choice questions on access to SRHR services and risk of SRHR violations, and written responses to open‐ended questions on threats to access and required response.ResultsThe survey was answered by 51 people representing 29 countries. Eighty‐six percent reported that access to contraceptive services was less or much less because of COVID‐19, corresponding figures for surgical and medical abortion were 62% and 46%. The increased risk of gender‐based and sexual violence was assessed as moderate or severe by 79%. Among countries with mildly restrictive abortion policies, 69% had implemented changes to facilitate access to abortion during the pandemic, compared with none among countries with severe restrictions (P < .001), 87.5% compared with 46% had implemented changes to facilitate access to contraception (P = .023). The content analysis showed that (a) prioritizations in health service delivery at the expense of SRHR, (b) lack of political will, (c) the detrimental effect of lockdown, and (d) the suspension of sexual education, were threats to SRHR access (theme 1). Requirements to mitigate these threats (theme 2) were (a) political will and support of universal access to SRH services, (b) the sensitization of providers, (c) free public transport, and (d) physical protective equipment. A contrasting third theme was the state of exception of the COVID‐19 pandemic as a window of opportunity to push forward women's health and rights.ConclusionsMany countries have seen decreased access to and increased violations of SRHR during the COVID‐19 pandemic. Countries with severe restrictions on abortion seem less likely to have implemented changes to SRHR delivery to mitigate this impact. Political will to support the advancement of SRHR is often lacking, which is fundamental to ensuring both continued access and, in a minority of cases, the solidification of gains made to SRHR during the pandemic.

Türk Yetişkinler Arasında Kürtaja Yönelik Toplumsal Tutumlar ve Dindarlık: İslami Perspektiften

For several decades, a handful of studies have examined the relationship between religion and abortion; they particularly pay attention to public attitudes. However, fewer quantitative studies have considered Muslims’ attitudes toward abortion. This study explores a new religious and traditional perspective that comes from Islam and also enhances the existing literature on the topic of religion and abortion. The significance of this study is based on the fact that Turkey, as well as its importance of geographical location and cultural heritage in today’s world, is one of two Muslim-populated countries in which performing abortion is legal. In order to measure the pulse of the public about this topic, we used data from the fourth wave of the European Value Study (2008). Our purpose is to display how religious factors influence people’s attitudes toward practicing abortion in the cases, “Women who are not married” and “A couple who does not want more children.” The findings indicate that people who have a high level of religiosity are more likely to disapprove of the practice of abortion. This finding also can be a considerable indicator of public attitudes regarding abortion to contribute to probable changes in the abortion policy of Turkey.

Association of Highly Restrictive State Abortion Policies With Abortion Rates, 2000-2014

Although abortion is common in the United States, patients face substantial barriers to obtaining an abortion. Recently enacted abortion restrictions pose such barriers. To assess the association between a state legislative climate that is highly restrictive toward abortion provision and the abortion rate and to evaluate whether distance to a facility providing abortion care mediates the association between legislative climate and the abortion rate. This cohort study examined county-of-residence abortion rates from all states that publicly provided them and used data on abortion restrictions, facility locations, and county demographic characteristics for the years 2000 to 2014. The association between legislative climate and abortion rates was evaluated using propensity score-weighted, linear regression difference-in-difference analysis. All models included state and year fixed effects and standard errors adjusted for state-level clustering. Highly restrictive legislative climate, defined as having at least 3 of 4 types of abortion restrictions; distance to a high-volume facility providing abortion care (ie, performing ≥395 abortions per year) in miles. County-level abortion rate, defined as abortions per 1000 women per year. Abortion rate data were obtained from 1178 counties in 18 states for a median of 12.5 years (range, 5-14). The median abortion rate was 2.89 per 1000 women (interquartile range, 1.71-4.46 per 1000 women). A highly restrictive legislative climate, when compared with a less restrictive one, was associated with 0.48 fewer abortions per 1000 women (95% CI, -0.92 to -0.04 abortions per 1000 women; P = .03). Adjusted for distance to a facility providing abortion care, a highly restrictive legislative climate was associated with 0.44 fewer abortions per 1000 women (95% CI, -0.85 to -0.03; P = .04). Each mile to a facility was associated with 0.02 fewer abortions per 1000 women (95% CI, -0.03 to -0.01 abortions per 1000 women; P = .003). Legislative climate was not significantly associated with distance to a facility providing abortion care (change in distance associated with highly restrictive climate, -2.73 [95% CI, -6.02 to 0.57] miles; P = .10). This study provides evidence that a state legislative climate that is highly restrictive toward abortion provision is associated with a lower abortion rate. The cumulative effect of restrictive policies may pose a barrier to abortion access.

The mesoeconomics of abortion: A scoping review and analysis of the economic effects of abortion on health systems.

BackgroundDespite the high incidence of abortion around the globe, we lack synthesis of the known economic consequences of abortion care and abortion policies at the mesoeconomic level (i.e. health systems and communities). This scoping review examines the mesoeconomic costs, benefits, impacts, and values of abortion care and policies.Methods and findingsSearches were conducted in eight electronic databases. We conducted the searches and application of inclusion/exclusion criteria using the PRISMA extension for Scoping Reviews. For inclusion, studies must have examined at least one of the following outcomes: costs, benefits, impacts, and value of abortion care or abortion policies. Quantitative and qualitative data were extracted for descriptive statistics and thematic analysis. Of the 150 included mesoeconomic studies, costs to health systems are the most frequently reported mesoeconomic outcome (n = 116), followed by impacts (n = 40), benefits (n = 17), and values (n = 11). Within health facilities and health systems, the costs of providing abortion services vary greatly, particularly given the range with which researchers identify and cost services. Financial savings can be realized while maintaining or even improving quality of abortion services. Adapting to changing laws and policies is costly for health facilities. American policies on abortion economically impact health systems and facilities both domestically and abroad. Providing post-abortion care requires a disproportionate amount of health facility resources.ConclusionsThe evidence base has consolidated around abortion costs to health systems and health facilities in high-income countries more than in low- or middle-income countries. Little is known about the economic impacts of abortion on communities or the mesoeconomics of abortion in the Middle East and North Africa. Methodologically, review papers are the most frequent study type, indicating that researchers rely on evidence from a core set of costing papers. Studies generating new primary data on mesoeconomic outcomes are needed to strengthen the evidence base.

Trends in Abortion Policies in Low- and Middle-Income Countries.

The decision to terminate a pregnancy is not one that is taken lightly. The need for an abortion reflects limited sexual autonomy, ineffective or lack of access to contraceptive options, or a health indication. Abortion is protected under human rights law. That notwithstanding, access to abortions continues to be contested in many parts of the world, with vested interests from politically and religiously conservative states, patriarchal societies, and cultural mores, not just within local contexts but also within a broader geopolitical context. Criminalization of a women's choice not to carry a pregnancy is a significant driver of unsafe procedures, and even where abortions are provided legally, the policies remain constrained by the practice or by a lack of coherence. This review outlines the trends in abortion policy in low- and middle-income countries and highlights priority areas to ensure that women are safe and able to exercise their reproductive rights.

When abortion becomes public - Everyday politics of reproduction in rural Zambia.

This article takes the public reaction to the discovery of an aborted foetus in a rural Zambian community as the empirical starting point for exploring the everyday politics of reproduction. It builds on eleven months of ethnographic fieldwork on abortion and abortion policy in Zambia in 2017 and 2018, including participant observation in the community where the episode took place and interviews with clinic staff and neighbours. The article explores local dynamics of abortion opposition in a country where abortion is legally permitted on broad grounds. By analysing this case as an anthropological event, it discusses how opposition to abortion is dynamic and changes depending on the situation at hand. While abortions that avoid public attention may be silently tolerated, abortions that become openly known are harshly condemned. Through scrutiny of a specific case of collective moral judgement of abortion, the article examines how values like responsible motherhood, sexual virtue and protection of life emerge and are shared, allowing participants to protect and accumulate their own integrity in a moral economy that forges stronger social ties within the community. The article argues that even the harshest expressions of opposition to abortion may not be as categorical as they first appear. It calls for increased attention to dynamics of moral and political opposition to abortion to understand what is socially at stake for those who engage in it.

Abortion regulation in Europe in the era of COVID-19: a spectrum of policy responses

BackgroundUnprecedented public health actions restricting movement and non-COVID related health services are likely to have affected abortion care during the pandemic in Europe. In the absence of a common approach...

Abortion restrictions in the state of Georgia: Anticipated impact on people seeking abortion

ObjectiveTo explore the impact of restrictive abortion policies in the state of Georgia on the lives of people seeking abortion and how they would manage unwanted pregnancies. Study designWe conducted a cross sectional study of English and Spanish-speaking people seeking abortion from three high-volume outpatient abortion clinics in Atlanta, Georgia from April 2019 through August 2019. Participants completed a multiple-choice questionnaire. We used bivariable and multivariable analysis to explore relationships between demographic characteristics and how people would manage their unwanted pregnancies if abortion were illegal in the state. Two researchers (EC and SC) conducted qualitative analysis on free response answers and coded them by key emotion. ResultsOf the 382 participants, 312 (81.9%) considered at least one way to end their pregnancy if abortion were illegal in Georgia: 252 (66.1%) by traveling to another state, 85 (22.3%) by self-management with medications and/or herbs, and 32 (8.4%) considered self-harm behaviors. When asked how they would feel about not being able to have a desired abortion, 94% reported negative emotions, ranging from “scared” to “enslaved.” ConclusionsLimiting access to legal abortion in Georgia would negatively impact the lives of people seeking abortion and has the potential to drive individuals to seek more costly and risky alternatives to end their pregnancy. ImplicationsRestricting abortion in Georgia may cause medically unnecessary delays in care, increased travel time, cost and negative emotional responses to people seeking abortion. Mitigating strategies include legislative challenges to restrictive laws as well as harm reduction education.

P16 State abortion policies and ability to obtain an abortion

Objectives: Most studies evaluating state policies or barriers to abortion are conducted among abortion patients, which limits our knowledge to only those able to access abortion care. We sought to understand the impact of state-level policies on obtaining an abortion among a pregnant population.

P32 The silent majority: Physicians’ knowledge of and attitudes toward restrictive abortion policies in a battleground state

P32 The silent majority: Physicians’ knowledge of and attitudes toward restrictive abortion policies in a battleground state

Kebijakan Kriminalisasi Pengguguran Kandungan dalam Kajian Perbandingan Hukum Berbagai Negara serta Dampaknya bagi Kesehatan Ibu dan Anak (KIA)

Indonesia is a country where religion occupies a central position and the elements must exist in the national and character building. Although has been setting in Criminal Code, but still found many cases of abortions. This paper is about to dig up how the rule of law of abortions. That there is something more profound that abortion is not only about removal of the fetus but also moral and psychological impact for youth of Indonesia. This artice aims to answer the questions: how the criminalization policy of abortion in the positive law at the future? In preparing this thesis, using a normative juridical approach, the author examines library materials is a secondary data and using the comparative law method also of the several foreign countries. The conclusion of this study is the criminalization of abortion policy set out in the positive law is not enough to guarantee protection for public health. Criminalization policy of abortion in the positive law at the future can be done by considering the arrangement of the Criminal Code abortion in some foreign as an ingredient to make legal reforms and especially considering the meaning of the precepts contained in the second sila in Pancasila. Advice can be delivered are abortions is not the best choice, but in conditions harmful should settings that give protection and health coverage of pregnant women; should have arrangements to sell the drug/vehicle used to perform abortions; about the naming of the chapter should considered using the chapter on offenses against the moral; rules should be formulated to provide legal certainty for doctors and patients: the criminalization policy of abortion settings should be based on Pancasila and national development goals.

A women’s right with limitations - global and European perspective on abortion decriminalization

Abstract Background The decriminalization of abortion is a controversial subject whose policies widely vary across the world. In some countries it is available upon request, at least up to the 24-week limit, while in others it is totally prohibited. This practice also raises ethical issues, since some defend access to abortion as a human right, while others condemn it, highlighting the embryo's right to life. This study aims to compare abortion decriminalization laws and the maximum gestational age limit for induced abortion in each country of the six WHO member states. Methods Data on abortion decriminalization laws and the maximum gestational age limit for induced abortion were collected from the Global Abortion Policies Database on the WHO website. Descriptive analysis of data considered absolute and relative frequencies. Comparison between regions considered the number of countries, including a deeper analysis for European context. Results Approximately 30% of reviewed countries have specific laws for abortion decriminalization, while in 48% it is still a prohibited practice. Among the 48 European countries, 29 have decriminalized abortion laws, a practice that is only considered in 5 of the 54 African countries. Considering abortion by women's request, accepted practices are valid between 8 and 24 weeks gestation, depending on each country. However, 12 weeks of gestation is the most frequent limit for abortion, and it is the threshold of increased bleeding risk for pregnant women. Conclusions No legal abortion practices are performed after fetal viability period, usually up to 24 weeks of gestation. There are relevant differences between six regions. While most high-income countries have decriminalized abortion, this practice is still prohibited in most South American and African countries, raising multiple public health issues. Cultural, sociological and healthcare context is expected to have a strong influence in decriminalization of abortion. Key messages Abortion is considered a human right but there are many countries that do not allow it, particularly in Africa and South America. Most European countries have abortion decriminalization laws.

Perspectives Among Canadian Physicians on Factors Influencing Implementation of Mifepristone Medical Abortion: A National Qualitative Study.

Access to family planning health services in Canada has been historically inadequate and inequitable. A potential solution appeared when Health Canada approved mifepristone, the gold standard for medical abortion, in July 2015. We sought to investigate the factors that influence successful initiation and ongoing provision of medical abortion services among Canadian health professionals and how these factors relate to abortion policies, systems, and service access throughout Canada. We conducted 1-on-1 semistructured interviews with a national sample of abortion-providing and nonproviding physicians and health system stakeholders in Canadian health care settings. Our data collection, thematic analysis, and interpretation were guided by Diffusion of Innovation theory. We conducted interviews with 90 participants including rural practitioners and those with no previous abortion experience. In the course of our study, Health Canada removed mifepristone restrictions. Our results suggest that Health Canada's initial restrictions discouraged physicians from providing mifepristone and were inconsistent with provincial licensing standards, thereby limiting patient access. Once deregulated, remaining factors were primarily related to local and regional implementation processes. Participants held strong perceptions that mifepristone was the new standard of care for medical abortion in Canada and within the scope of primary care practice. Health Canada's removal of mifepristone restrictions facilitated the implementation of abortion care in the primary care setting. Our results are unique because Canada is the first country to facilitate provision of medical abortion in primary care via evidence-based deregulation of mifepristone.

Student's attitudes towards induced abortion and its associated factors

Abstract Background At present, the legal status of abortion worldwide is maintained heterogeneously. In Mexico, its practice is allowed within the capital of the country and one more state, provided that it is before the 12th week, however in the rest of the country it is still classified as illegal. Research question: What are the factors associated with the modification of attitudes towards abortion? Methods An observational, prospective, cross-sectional and analytical study was conducted in Veracruz, Mexico between December 2019 and March 2020. University students from public and private schools were included, from the city of Veracruz-Boca del Río, selecting the participants through a non-probabilistic sampling. The Attitudes Abortion Questionnaire was applied to assess the attitudes provided, pro-selection, reproductive rights, health risk and legalization. The surveys were conducted through Google Forms® and were answered on that same platform. The results were collected and analyzed with the SPSS Statistic® program. Results 517 students were included. Private school students showed differences in pro-election attitudes when compared to public, students from urban areas had more pro-election attitudes and in favor of reproductive law compared to those from rural areas, having active sex life and having someone known to having performed induced abortion favors the attitude of pro-choice, reproductive rights and the legalization of abortion as a means of solution for its complications, and detracts from the position provided, in both situations (p &amp;lt; 0.05). The strong religioside is the one who has the main differences showing less points in the pro-election, reproductive law and legalization as a solution and more in being provided. (p &amp;lt; 0.001) Conclusions The social context still manifests itself uneven at the moment of having a posture and attitude with the legalization of induced abortion, being strong, independent of religion strong beliefs in a god. Key messages University students are in different positions before abortion according to their social and cultural context. The regulation of the abortion policy will have to contemplate the particular Mexican situation taking into account its social fabric and the moment in which it lives.

Pregnancy and Abortion: Experiences and Attitudes of Deployed U.S. Servicewomen.

More U.S. servicewomen than civilian women experience unintended pregnancies, which can impact their health, well-being, and careers. Despite this, federal policy limits abortion access and coverage for military personnel to cases of rape, incest, and life endangerment. This study aimed to document servicewomen's experiences with unintended pregnancy and abortion during deployment, and their knowledge and opinions of military policies related to sexual activity, pregnancy, and abortion. Between June 2016 and July 2017, we conducted a cross-sectional online survey among a convenience sample of current and former U.S. Military, National Guard, and Reserves members whose last deployment ended in 2010 or later. We asked open- and closed-ended questions about demographics, experiences with pregnancy and abortion during deployment, and knowledge and opinions of military policies related to sexual activity, pregnancy, and abortion. We ran descriptive statistics on closed-ended questions and inductively coded open-ended question responses. This study was approved by the Allendale Investigational Review Board. A total of 319 participants were included. The majority said that servicewomen are reprimanded for sexual activity and becoming pregnant during deployment in all or some circumstances. Among these respondents, one-third said that fear of reprimand for sexual activity affects deployed servicewomen's use of contraception. Twenty respondents became pregnant or discovered that they were pregnant during deployment; twelve were unable to access the pregnancy- and/or abortion-related services they wanted or needed. Among those whose last deployment ended in 2013 or later (n=141), when federal policy expanded abortion coverage for servicemembers to include cases of rape and incest, the minority knew the correct coverage or provision policies for abortion in cases of rape and incest or life endangerment. The majority believed that the military should cover and provide abortion in cases of rape, incest, or life endangerment and for unwanted pregnancies. Among this convenience sample of current and former servicewomen with an overseas deployment that ended in 2010 or later, 6% became pregnant or discovered that they were pregnant during deployment, and most of these respondents reported being unable to access the pregnancy- and/or abortion-related services they wanted or needed. The majority reported lack of knowledge of military abortion policies and that servicewomen are reprimanded for pregnancy and/or sexual activity in some or all circumstances, with many noting this reprimand as a barrier to contraceptive use for some servicewomen. Predeployment health visits may be one intervention point for disseminating the military's abortion policies; commanding officers should also be well versed in these policies so that they are able to provide effective leadership to junior military members.

Legacy and Legality of Abortions in India and USA

Abortion is one issue that has been debated expansively in both national and international level. It has become a contentious issue round the globe. Every Tom, Dick, and Harry is in a predicament whether a mother has the solitary right to choose if or not to have her pregnancy terminated at any time she wishes or whether a child that is yet to see the world, has a right to life or not. Right to life is a very broad and a rather fundamental concept out of everything else. In India, Right to Life is well recognized and secure under Article 21 of the Constitution to all persons which include men as well as women. But the main issue that always takes the lead is whether an unborn child should be considered as a “person” and thus be eligible for protection under this article. There are several aspects such as religious, ethical, moral and legal values that rule against the right to abortion. Termination of pregnancy is considered as a sin under almost all religions all over the world. But, regardless of this, this is an on-going debate and tussle between the woman and the fetus. Due to all the tumult surrounding the question of abortion, it has turned out to be undeniably serious at this stage to look at the expansion of abortion law and policies in the West, particularly the United States, and to scale where India stands at this instant and, if at all, India should take inspiration by their western counterpoint or should it practice caution from the advances therein to supplement their own welfare in striking the seamless stability amongst liberty, self-sufficiency and freedom of the individual on the one hand and the State’s right to hinder on the other.

Striving to Rollback or Protect Roe: State Legislation and the Trump-Era Politics of Abortion

AbstractAbortion’s centrality to the Christian Right, together with that movement’s importance to Republican Party politics, as well as the policy realities of abortion, have all combined to make regulating abortion a fixture within U.S. state politics for decades. While the levels and forms of state activity have varied since the 1980s, the Trump presidency has produced strategic changes in the content and perceived importance of abortion policy. Notably, recent changes in the state politics of abortion have not just been on the side of Republican states restricting abortion access, the most traditional and highest profile form of policy activity in this area, but have also taken the form of Democratic states actively defending abortion access. This article provides an overview of the interrelated changes in party politics, perceptions of political opportunities, and the content of state abortion regulations. It concludes that the frequency of state abortion laws has increased modestly during the Trump presidency, but substantive shifts in recent policies create the potential to fundamentally reorganize state and national abortion politics.

Legal Epidemiology For A Clearer Understanding Of Abortion Laws And Their Impact

The global abortion field has a murky understanding of the impact of abortion laws. With legal epidemiology, legal and scientific researchers can together produce a clearer view of the relationships between laws and public health outcomes. Scientists study public health with a required degree of rigor, while the global study of abortion laws and how they impact public health outcomes remains less developed. Global abortion researchers tend to focus on the circumstances in which abortion is legal as the independent variable when investigating public health outcomes. Other provisions such as who is authorized to provide abortions—particularly in countries where health care professionals are inaccessible—may have an even greater impact. But gaps in evidence of impact persist. Legal epidemiology, broadly, and policy surveillance, specifically, offer theories and methods that researchers can apply to the study of the impact of abortion laws on public health outcomes. The World Health Organization took a giant step toward making abortion laws accessible through the Global Abortion Policies Database; policy surveillance would add rigor and enable researchers to study laws over time. A better global understanding of the relationships between abortion laws and public health outcomes is urgent, as a growing number of people experiencing displacement and an increase in the practice of self-managed abortion complicates the impact of law. With good evidence on the relationships between laws and public health outcomes, people working to improve abortion access can more precisely target their efforts and resources to improve the health and lives of people who have abortions.

How task-sharing in abortion care became the norm in Sweden: A case study of historic and current determinants and events.

We performed a country case study using thematic analysis of interviews and existing grey and published literature to identify facilitators and barriers to the implementation of midwife‐provided abortion care in Sweden. Identified facilitating factors were: (1) the historical role and high status of Swedish midwives; (2) Swedish research and development of medical abortion that enabled an enlarged clinical role for midwives; (3) collaborations between individual clinicians and researchers within the professional associations, and the autonomy of clinical units to implement changes in clinical practice; (4) a historic precedent of changes in abortion policy occurring without prior official or legal sanction; (5) a context of liberal abortion laws, secularity, gender equality, public support for abortion, trust in public institutions; and (6) an increasing global interest in task‐shifting to increase access and reduce costs. Identified barriers/risks were: (1) the lack of systems for monitoring and evaluation; and (2) a loss of physician competence in abortion care.