Abortion Policy Research Articles

Attitudes and Laws About Abortion Are Linked to Extrinsic Mortality Risk: A Life-History Perspective on Variability in Reproductive Rights

Abortion policy is conventionally viewed as a political matter with religious overtones. This article offers a different view. From the perspective of evolutionary biology, abortion at a young age can represent prioritization of long-term development over immediate reproduction, a pattern established in other animal species as resulting from stable ecologies with low mortality risk. We examine whether laws and moral beliefs about abortions are linked to local mortality rates. Data from 50 U.S. states, 202 world societies, 2,596 adult individuals in 363 U.S. counties, and 147,260 respondents across the globe suggest that lower levels of mortality risk are associated with more permissive laws and attitudes toward abortion. Those associations were observed when we controlled for religiosity, political ideology, wealth, education, and industrialization. Integrating evolutionary and cultural perspectives offers an explanation as to why moral beliefs and legal norms about reproduction may be sensitive to levels of ecological adversity.

Abortion Legal Reform and Neonatal Mortality in Mozambique.

Abortion law reforms have been hypothesized to influence reproductive, maternal, and neonatal health services and health outcomes, as well as social inequalities in health. In 2014, Mozambique legalized abortion in specific circumstances. However, due to challenges implementing the law, there is concern that it may have negatively influenced neonatal outcomes. Using a difference-in-differences design, we used birth history data collected via the Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) between 2004 and 2018 to assemble a panel of 476 939 live births across 17 countries including Mozambique. We estimated the effect of the abortion reform on neonatal mortality by comparing Mozambique to a series of control countries that did not change their abortion policies. We also conducted stratified analyses to examine heterogeneity in effect estimates by household wealth, educational attainment, and rural/urban residence. The reform was associated with an additional 5.6 (95% CI = 1.3, 9.9) neonatal deaths per 1,000 live birth. There was evidence of a differential effect of the reform, with a negative effect of the reform on neonatal outcomes for socially disadvantaged women, including those with no schooling, in poorer households, and living in rural areas. Given the delay in implementation, our analyses suggest that abortion reform in Mozambique was associated with an initial increase in neonatal mortality particularly among socially disadvantaged women. This may be due to the delay in effective implementation, including the dissemination of clear guidelines and expansion of safe abortion services. Longer-term follow-up is needed to assess the impact of the reform after 2018, when services were expanded. Abortion legal reform without adequate implementation and enforcement is unlikely to be sufficient to improve abortion access and health outcomes.

Open Season: The Targets of Dobbs

ABSTRACT Dobbs v. Jackson Women’s Health Organization took the unprecedented step of revoking a constitutional right that citizens had relied upon for half a century. The opinion created a legal chaos with no clear answers to medical crises. It also targets victims who are particularly vulnerable due to financial, medical, or legal constraints. This article examines what groups have become legal targets in the wake of Dobbs, including medically compromised patients, the intellectually disabled, immigrants, and doctors. Also discussed are those who cause abortion but have not been targeted by Dobbs (such as biological fathers and criminals who commit acts of rape or incest). A discussion of who is doing the targeting examines officials acting in a law enforcement capacity and “civilians” who have financial incentives to target vulnerable victims. Recommendations are made for effective abortion policy.

Multicountry research on comprehensive abortion policy implementation in Latin America: a mixed-methods study protocol

IntroductionAccess to comprehensive abortion care could prevent the death of between 13 865 and 38 940 women and the associated morbidity of 5 million women worldwide. There have been some...

Institutional leadership after Dobbs: a mixed methods analysis of US medical schools' public statements regarding abortion

IntroductionMedical schools, as significant and influential organisations within their communities, have the potential and the capacity to impact abortion policy. Organisations often engage in advocacy by issuing public statements that...

Comparison of the efficacy of paracervical block in first-trimester surgical abortion to endometrial sampling and its relation to anxiety

Psychological support, premedication with analgesics, and local anesthesia are the most widely used methods for pain management during gynecological surgeries. The World Health Organization's (WHO) Safe Abortion Technical and Policy Guidance for Health Systems Guideline recommends the use of manual vacuum aspiration for first-trimester induced abortions for pain management. We aimed to compare the efficacy of lidocaine used for pain management in first-trimester voluntary termination to endometrial sampling and its relation to anxiety.

The impact of hostile abortion legislation on the United States maternal mortality crisis: a call for increased abortion education.

The growing restrictive abortion policies nationwide and the Supreme Court decision on Dobbs v. Jackson Women's Health Organization place increasing barriers to abortion access in the United States. These restrictions disproportionately affect low-income people of color, immigrants, and non-English speakers, and have the potential to exacerbate already existing racial inequities in maternal and neonatal outcomes. The United States is facing a Black maternal health crisis where Black birthing people are more than twice as likely to experience maternal mortality and severe maternal morbidity compared to White birthing people. Restrictions creating geographic, transportation, and financial barriers to obtaining an abortion can result in increased rates of maternal death and adverse outcomes across all groups but especially among Black birthing people. Restrictive abortion laws in certain states will decrease already limited training opportunities in abortion care for medical professionals, despite the existing abortion provider shortage. There is an immediate need for federal legislation codifying broad abortion care access into law and expanding access to abortion training across medical education. This commentary explores the impact of restrictive abortion laws on the Black maternal health crisis through multiple pathways in a logic model. By identifying current barriers to abortion education in medical school and residency, we created a list of action items to expand abortion education and access.

Unruly bodies (of knowledge): influencing Irish abortion policy through evidence-based abortion activism

Abstract The involvement of grassroots activist groups in the production of knowledge used to challenge or inform abortion policy remains underexplored. Despite this, modes of abortion activism which incorporate knowledge production activities are increasingly common. In this article, we propose the term ‘evidence-based abortion activism’ to describe knowledge production activities by activist groups, which aim to influence abortion policy and provision and which advocate for the lived, embodied experiences of abortion-seekers as crucial forms of knowledge for policymaking. As a case study, we present research by the Abortion Rights Campaign (ARC) – a grassroots organization which campaigns for free, safe, and legal abortion across Ireland – analysing the experiences of those who have accessed or attempted to access abortion care in the Republic of Ireland since legal services were made available there in January 2019. This article explores one sub-section of ARC’s data, relating to the strikingly negative experiences of abortion-seekers attempting to access care between ten and twelve weeks in Irish hospitals: a thus far underexplored aspect of abortion experience in the Republic of Ireland. We argue that evidence-based abortion activism such as that carried out by ARC is important, not only because it provides a method for activists to attempt to influence abortion policy and provision but also because it creates space for forms of evidence which are epistemologically and politically ‘unruly’ in political debate and policy discussions. Specifically, ARC’s model of evidence-based abortion activism argues that the embodied testimonies of abortion-seekers themselves must be fully integrated and considered in policymaking to improve the material experience of abortion-seekers.

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).

Does Abortion Liberalisation Accelerate Fertility Decline? A Worldwide Time-Series Analysis

Since WWII, the two most important global trends in family planning have been fertility decline and abortion liberalisation. But are they related? Specifically: Does abortion liberalisation affect changes in fertility rates? The demographic literature has yet to answer this important question and instead offers two opposing predictions. Some studies argue that liberalisation of this medical procedure reduces fertility rates. By contrast, others note that such legal reforms may merely have an average, negligible effect on fertility levels. We adjudicate between the two approaches by conducting, in our view, the most comprehensive global, quantitative analysis of the relationship between those legal reforms and changing fertility rates. The analysis relies on two-way fixed models and three different indicators of abortion policy liberalism created by independent research teams to estimate the relationship between abortion liberalisation and total fertility changes. The data cover 185 independent states between 1970 and 2019. Fertility rates are significantly related to average public education levels and alternative contraceptive use. Using multiple model specifications, however, abortion reforms do not have a robust association with the outcome. Replication materials for this article can be found at https://figshare.com/s/5336a4422f47c8c39228.

ABORSI: ANTARA DIALEKTIKA MORAL DAN KEBIJAKAN HUKUM PIDANA INDONESIA

This research examines the moral and legal dialectics in viewing abortion as well as the construction of abortion policy in the Indonesian criminal law system after the passing of Law Number 1 of 2023 concerning the Criminal Code and Law Number 17 of 2023 concerning Health. The method used is a normative research method with a statutory and conceptual approach. The research results show that abortion cannot only be viewed in legal terms, but it is important to pay attention to moral aspects. Law is a law that is filled with morality so that it does not result in conflict between norms and society. Morality is the main source of law, especially in Indonesia which is based on Pancasila in all aspects of state life. Next, Indonesia's criminal law policy allows abortion under strict conditions, namely if the woman is a victim of a crime of rape or other crime of sexual violence that causes pregnancy, the gestational age does not exceed the permitted age, and/or has indications of a medical emergency. If the conditions are not met, then the perpetrator of the abortion, whether the main perpetrator, the participating perpetrator, and the person who assists in carrying out the abortion, can be punished

Effects of State-Level Abortion and LGBT Laws and Policies on Interstate Migration Attitudes

Effects of State-Level Abortion and LGBT Laws and Policies on Interstate Migration Attitudes

Mental health and abortions among young women: time-varying unobserved heterogeneity, health behaviors, and risky decisions

In this paper, we provide causal evidence on abortions and risky health behaviors as determinants of mental health development among young women. Using administrative in- and outpatient records from Sweden, we apply a novel grouped fixed-effects estimator proposed by Bonhomme and Manresa (2015) to allow for time-varying unobserved heterogeneity. We show that the positive association obtained from standard estimators shrinks to zero once we control for grouped unobserved heterogeneity that varies across ages. We estimate the group profiles of unobserved heterogeneity, which reflect differences in unobserved risk to be diagnosed with a mental health condition. In addition, we analyze mental health development and risky health behaviors other than unintended pregnancies across groups. Our results suggest that these are determined by the same type of unobserved heterogeneity, which we attribute to the same unobserved process of decision-making. We develop and estimate a theoretical model of risky choices and mental health that is consistent with our empirical results. In the model, mental health disparity across groups is generated by different degrees of self-control problems. Our findings imply that mental health concerns cannot be used to justify restrictive abortion policies.

Abortion as healthcare: The adaptability of medicalization and legalization in post‐repeal anti‐abortion politics

AbstractAfter a 35‐year‐long constitutional ban on abortion, the Eighth Amendment was repealed in May 2018 and the Health (Regulation of Termination of Pregnancy) Act 2018 was introduced in the Republic of Ireland. Although “Repeal” and the legalization of abortion marked a significant transformation in reproductive governance, many aspects of the new abortion policy continue to complicate abortion care access and provision. In this article, I explore the mobilizations of health and rights in political discourses on abortion after legalization. In doing so, I identify how moral governance operates in post‐Repeal abortion politics. I critically consider restrictive strategies in abortion politics in Ireland and compare these to a number of recent key anti‐abortion tactics in the United States. As such, I situate post‐Repeal and post‐Roe abortion debates within parallel temporalities of abortion governance and highlight the adaptability of discourses on health and rights in shifting legal contexts.

Abortion Policy: Legal, Clinical, and Medical Education Considerations.

Abortion is a frequent topic of policy debate in America and a central issue in politics since the Dobbs v Jackson Women's Health Supreme Court decision. A number of states have completely or nearly completely banned abortion and criminalized health care providers. People seeking abortion care are turning to alternatives outside the formal health care system or traveling to states that have preserved access. Approximately half of US Obstetrics/Gynecology residents will train in a state where abortion is illegal, lending to a frightening future where Obstetrics/Gynecologists are not trained to provide this common, sometimes life-saving, health care.

State-Level Abortion Policy Hostility and Unplanned Births in the Pre-Dobbs Era

An increasingly hostile policy climate has reshaped abortion access in the United States. Recent literature has studied the effects of restrictive abortion policies on reproductive health outcomes. This study is the first to investigate the association between state-level abortion policy hostility and the pregnancy intentions of women with a pregnancy resulting in live birth. Data are from the Pregnancy Risk Assessment Monitoring System survey, merged with a state-level legislative database from 2012–2018 and other state-level controls. Cross-sectional results reveal that a one-unit increase in abortion policy hostility is associated with a relative risk (odds) of having a live birth resulting from an unintended versus intended pregnancy that is 1.02 times as high (RRR = 1.02, 95% confidence interval = 1.01, 1.03). This result corresponds to a 13% increase in the predicted probability of having a live birth resulting from an unintended pregnancy between a zero-hostility and a maximum-hostility state. Models stratified by demographic and socioeconomic characteristics reveal that the association between abortion policy hostility and live birth resulting from an unintended pregnancy is particularly robust among women in younger, less educated, Medicaid, uninsured, and rural populations.

50.5 Abortion Policy and Mental Health Outcomes for Families

50.5 Abortion Policy and Mental Health Outcomes for Families

50.1 United States Abortion Policy Landscape

50.1 United States Abortion Policy Landscape

Physician beliefs about abortion safety and their participation in abortion care

ObjectiveTo document physicians’ beliefs about abortion safety and the associations between these beliefs and physician support for, referral for, and participation in abortion care. MethodsIn a 2019 survey at the University of Wisconsin School of Medicine and Public Health, we assessed physicians’ abortion attitudes, beliefs, and practices (N = 893). We conducted bivariate analyses followed by logistic regression to document relationships between physician beliefs about abortion safety and their support for, referral to, and participation in abortion care. ResultsFour-in-five physicians (78%, n = 690) believed that abortion is very or extremely safe. Medical specialty (Obstetrics-Gynecology vs. other; adjusted odds ratio [aOR] = 10.58, 95% CI: 1.41–79.56), educational exposure to abortion (aOR = 1.43, 95% CI: 1.02–2.01), and religiosity (aOR = 0.59, 95% CI: 0.41–0.85) were associated with physicians’ beliefs about the safety of abortion. Providers who believed that abortion was very/extremely safe were more likely to support medication (aOR = 2.99, 95% CI: 1.93–4.65) and procedural abortion (aOR = 3.56, 95% CI: 2.31–5.50) and refer patients for abortion care (aOR = 3.14, 95% CI: 1.90–5.01). ConclusionAlthough abortions are associated with extremely few adverse events, a sizable portion of surveyed physicians had incorrect perceptions of the safety of abortion. These beliefs were associated with decreased support and referrals for abortion care. Educational exposure to abortion is associated with more accurate assessments of abortion safety, underscoring the importance of training in this area. Considering the current abortion policy landscape, it is imperative for physicians to hold accurate knowledge about abortion so they can provide comprehensive counseling and, when indicated, referrals for safe and legal care.

The influence of gerrymandering on abortion policy in the United States

Background: When the U.S. Supreme Court in Dobbs v. Jackson Women’s Health Organization (2022) overruled a five-decade old precedent and gave states the unfettered power to regulate or ban abortion, it did so while proclaiming the decision would return power over the issue to the people, and that women specifically were not without political influence to shape policies. Nowhere amid such language about the power of the people does the Court decision acknowledge the capacity for biased legislative district maps (i.e., gerrymandering) to influence resulting policies. Methods: Here I consider the state-level relationship between gerrymandering and abortion policy using logistic regression that controls for several variables including statewide public opinion, religion, and the number of women legislators. Data on abortion rules are derived from the Guttmacher Institute’s database as of January 1, 2023. Data on gerrymandering scores for each legislative map are derived from the Campaign Legal Center. Results: I find that states with a pro-Republican gerrymander were considerably more likely to impose a pre-viability abortion ban in 2023. Across the 50 states, the logistic regression results suggest an increase in the odds of an abortion ban by more than 40 times as a result of a pro-Republican legislative map gerrymander. Notably, a pre-viability abortion ban is in place in nine of the 10 states where public opinion favors abortion rights but where the legislative map is biased toward Republicans. Conclusions: The influence of mapmakers over the resulting policy clouds the Court’s sanguine assertions of the public’s influence and women’s political agency over this issue.