Access To Abortion Research Articles

Dispensing mifepristone for medical abortion in Canada: Pharmacists' experiences of the first year.

Mifepristone for medical abortion was first dispensed by community pharmacists in Canada directly to patients in January 2017. We asked about pharmacists' experiences over their first year dispensing mifepristone in order to evaluate the frequency of the new practice and assess availability in urban/rural pharmacies. From August to December 2019, we invited 433 community pharmacists who had completed a baseline survey at least 1 year prior to participate in a follow-up online survey. We summarized categorical data using counts and proportions and conducted a qualitative thematic analysis of open-ended responses. Among 122 participants, 67.2% had dispensed the product, and 48.4% routinely stocked mifepristone. Pharmacists reported a mean of 26 and median of 3 (interquartile range, 1, 8) mifepristone prescriptions filled in their pharmacies in the previous year. Participants perceived that the benefits of making mifepristone available in pharmacies included increased abortion access for patients (n = 115; 94.3%), reduced pressure on the health care system (n = 104; 85.3%), increased rural and remote abortion access (n = 103; 84.4%) and increased interprofessional collaborations (n = 48; 39.3%). Few participants reported challenges to maintaining adequate stock of mifepristone, but these challenges included low demand (n = 24; 19.7%), short expiry dating (n = 12; 9.8%) and drug shortages (n = 8; 6.6%). The overwhelming majority, 96.7%, reported that their communities did not resist the provision of mifepristone by their pharmacy. Participating pharmacists reported many benefits and very few barriers to stocking and dispensing mifepristone. Both urban and rural communities responded positively to enhanced access to mifepristone in their community. Mifepristone is well accepted by pharmacists within the primary care system in Canada.

Adolescent Awareness of the Changing Legal Landscape of Abortion in the United States and Its Implications

PurposeRestrictions on abortion in the United States will have disproportionate and negative impacts on adolescents. Prior to the Supreme Court ruling to overturn federal protection of abortion, we sought to examine adolescents' awareness and knowledge about the legal landscape of abortion and how changes might affect them. MethodsWe fielded a 5-question open-ended survey via text message to a nationwide sample of adolescents aged 14–24 years on May 20, 2022. We coded the responses using inductive consensus coding. Summary statistics were calculated for code frequencies and demographic data, and analyzed qualitatively using visual inspection of results overall and by subgroups (e.g., age, race and ethnicity, gender, and restrictiveness of state of residence). ResultsA total of 654 responded (79% response rate), of which 11% were under 18 years. Most adolescents were aware of potential changes to abortion access. Most adolescents reported using the internet and social media for information about abortions. Overall, negative emotions about the changing legal landscape predominated, including anger, fear, and sadness. When considering factors for abortion decisions, adolescents most often discussed finances and life circumstances including their future, age, education, maturity, and emotional stability. Themes were relatively, uniformly distributed across subgroups. DiscussionOur study suggests that many adolescents are aware of and concerned about potential impacts of abortion restrictions, across a diversity of ages, gender, racial/ethnic, and geographic perspectives. Understanding and amplifying the voices of adolescents during this critical time is necessary to inform novel access solutions and policy initiatives that center the needs of youth.

Reworking Emergency Medicine Resident Education Post-Dobbs v Jackson Women's Health Organization.

Reworking Emergency Medicine Resident Education Post-Dobbs v Jackson Women's Health Organization.

Awareness of medication abortion among a nationally representative U.S. sample, 2021–2022

ObjectivesAssess public awareness of medication abortion in the U.S. Study designWe conducted a cross-sectional survey in 2021–2022 with a probability-based sample, calculating the prevalence of medication abortion awareness and assessing its associations with participant characteristics using multivariable logistic regression. ResultsA total of 45% of adults (7201/16,113) and 49% of eligible 15–17-year-old females (175/358) invited completed the survey. In all, 64% of 6992 participants assigned female at birth, and 57% of 360 participants assigned male reported awareness of medication abortion. Race, age, education, poverty level, religion, sexual identity, abortion history, and attitudes toward abortion legality were associated with differences in awareness. ConclusionsMedication abortion awareness differs by participant groups and is critical for expanding abortion access. ImplicationsTailored health information for groups with less awareness of medication abortion may help spread knowledge of the method and how to access it.

Abortion Access as a Racial Justice Issue

(N Engl J Med. 2022;387:1537–1539) Improvement of racial equity in health care is a significant priority for research and policy, as disparity in outcomes is readily apparent. The landmark US Supreme Court ruling on Dobbs v. Jackson Women’s Health in June 2022 severely constrained access to abortion, a procedure considered an essential element of comprehensive reproductive care. The legal status of abortion impacts the civil rights of all with the capacity for pregnancy, but has strong reverberations in the Black and Indigenous populations of the United States, who have historically suffered from acute reproductive oppression. Abortion access is proposed as a racial justice issue that should be addressed by policymakers, health care organizations and clinicians.

A national analysis of ED presentations for early pregnancy and complications: Implications for post-Roe America

BackgroundMost obstetric emergencies are initially managed in the emergency department (ED). The Supreme Court decision of Dobbs v. Jackson Women's Health Organization, overturning Roe v. Wade, in June 2022, eliminated constitutional protection of abortion rights, allowing states to swiftly enact laws that can greatly change reproductive medicine. In this post-Roe landscape, the ambiguity and uncertainty being imposed on clinicians regarding the legality of certain interventions may have catastrophic effects. To understand and plan for the changes that will come and attempt to mitigate adverse outcomes, the authors first assessed the current state of pregnancy-related complication care in the ED setting. This study utilized data obtained from the National Hospital Ambulatory Medical Care Survey (NHAMCS) to evaluate trends in pregnancy-related ED visits from 2016 to 2020 that could be impacted by restricted abortion access and trigger laws. The authors subsequently analyzed the legislative changes and translated the pertinent ones to dispel misunderstandings and provide a framework for appropriate medical practice. MethodsThe retrospective study utilized data from the NHAMCS database from 2016 to 2020, encompassing an estimated total of 4,556,778 pregnancy-related ED visits. NHAMCS is a multi-stage probabilistic sample collected by the National Center for Health Statistics (NCHS) at the Centers for Disease Control and Prevention (CDC) using an annual survey of EDs in the United States. All data were summarized using descriptive statistics such as proportions and 95% confidence intervals Furthermore, the supreme court decision was analyzed in addition to multiple state laws and legal texts. The findings were summarized and discussed. ResultsThe majority (79.4%) of all studied visits were for patients between the ages of 18–34 years, capturing those in peak reproductive years. This age group also comprised of the bulk (76.4%) of visits for pathologic pregnancies, including ectopic and molar pregnancies, and 79.8% of visits for a spontaneous miscarriage or threatened miscarriage in early pregnancy. Black patients accounted for 25.7%, white patients 70.1%. Regarding ethnicity, patients were separated into Hispanic and non-Hispanic, with Hispanic patients comprising 27% of all ED visits for included diagnoses between 2016 and 2020. Most visits for complications following an induced abortion occurred in the south (70.8%) and were nearly twice as likely to occur in non-metropolitan areas. Approximately 18% patients presenting with a pathologic pregnancy required admission to the hospital and approximately 50% of those visits for pathologic pregnancies and visits for bleeding in pregnancy had a procedure in the ED (49.8% and 49.5%). There were 111,264 estimated visits in which methotrexate was administered, amounting to approximately 1 in 7 visits for ectopic or molar pregnancy. In this data set, approximately 14,000 miscarriage and early bleeding patients received misoprostol. ConclusionPregnancy-related ED visits comprise of a significant proportion of emergency care. As it relates to many of the trends previously elucidated on, the true extent of the burden cannot be predicted. It must be emphasized that contrary to popular belief, Dobbs v. Jackson does not prohibit termination of pregnancy in the setting of life-threatening conditions to the mother, including ectopic pregnancy, preeclampsia, and others, but the resultant uncertainty and ambiguity surrounding the constitutional change is leading to an over-compliance of the law, necessarily obstructing reproductive health care. The authors recommend that physicians be mindful of the rapidly-evolving laws in their particular state, and to also practice in accordance with Emergency Medical Treatment and Active Labor Act (EMTALA). Patient safety must be prioritized.

Accompaniment on the edge: What can the US learn from Latin America about contested abortion care?

The US has stood as a reference point for abortion rights in the Americas since 1973, however in 2022, the US Supreme Court revoked the constitutional right to abortion. Facing similar circumstances, a huge number of grass roots accompanist networks have arisen throughout Latin America. These collectives are typically organized loosely within state and national networks that provide training and medication/supplies and promote advocacy and the expansion of new collectives. Extensive evidence and lived experience support the safety and effectiveness of self-managed medication abortion. Much can be learned from the Latin American accompanist model in the modern struggle for reproductive justice in the US. Accompaniment networks in Mexico have provided transborder abortion services-via misoprostol delivery-to US-based women living in states that required long travel or high costs to access services. Now, these transborder services will take on a new level of significance. Guaranteeing safe and low-cost access to abortion services is a key tenet of reproductive justice. Instead of relying on the political process alone to eventually provide abortion access through legal channels, an accompanist model provides an icon of resistance to oppressive legal shifts, and directly provides services to women.

The association between reproductive rights and access to abortion services and mental health among US women

BackgroundThis study examines whether living in US states with (1) restrictive reproductive rights and (2) restrictive abortion laws is associated with frequent mental health distress among women. MethodsWe operationalize reproductive rights using an overall state-level measure of reproductive rights as well as a state-level measure of restrictive abortion laws. We merged data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS) with these state-level exposure variables and other state-level information. We used multilevel logistic regression to assess the relationship between these two measures and the likelihood of reporting 14 or more days of frequent mental health distress. We also tested whether associations differed across race, household income, education, and marital status. ResultsIn the adjusted models, a standard deviation-unit increase in the reproductive rights score was significantly associated with decreased odds of reporting frequent mental health distress (OR = 0.95, 95% CI = 0.91, 0.99). Women in states with very hostile abortion restrictions had higher odds of frequent mental health distress. Associations between state-level abortion restrictions were larger among women 25–34 years old and women with a high school degree. For example, women aged 25–34 years residing in moderate (OR = 1.54, 95% CI = 1.14, 2.04), hostile (OR = 1.59, 95% CI = 1.15, 2.18), and very hostile (OR = 1.29, 95% CI = 1.02, 1.64) states were more likely to report frequent mental health distress than women living in states with less restrictive abortion policies. ConclusionWe found the association between state-level restrictions on reproductive rights and abortion access and frequent mental health distress differed by age and socioeconomic status. These results suggest abortion rights restrictions may contribute to mental health inequities among women.

"I'm going to be forced to have a baby": A study of COVID-19 abortion experiences on Reddit.

The initial stages of the COVID-19 pandemic affected abortion care in the United States (US) in myriad ways. While research has documented systems-level pandemic-related impacts on abortion access and care delivery little information exists about the experiences of abortion seekers during this period. We sought to document the effects of COVID-19 pandemic restrictions US abortion seekers by analyzing posts on Reddit, a popular social media website. We compiled and coded 528 anonymous posts on the abortion subreddit from 3/20/2020 to 4/12/2020 and applied inductive qualitative analytic techniques to identify themes. We identified four primary themes. First, posters reported several COVID-19-related barriers to abortion services: reduced in-person access due to clinic closures, mail delivery delays of abortion medications, and pandemic-related financial barriers to both self-managed and in-clinic abortion. The second theme encompassed quarantine-driven privacy challenges, primarily challenges with concealing an abortion from household members. Third, posters detailed how the pandemic constrained their pregnancy decision making, including time pressure from impending clinic closures. Finally, posters reported COVID-19-related changes to service delivery that negatively affected their abortion experiences, for example being unable to bring a support person into the clinic due to pandemic visitor restrictions. This analysis of real-time social media posts reveals multiple ways that the COVID-19 pandemic limited abortion access in the US and affected abortion seekers' decisions and experiences. Findings shed light on the consequences of sudden changes, whether pandemic or policy related, on abortion service delivery.

Self-diagnosing the end of pregnancy after medication abortion

This qualitative study conducted between November 2020 and March 2021 in the US state of Mississippi examines the experiences of 25 people who obtained medication abortion at the state’s only abortion facility. We conducted in-depth interviews with participants after their abortions until concept saturation was reached, and then analysed the content using inductive and deductive analysis. We assessed how people use embodied knowledge about their individual physical experiences such as pregnancy symptoms, a missed period, bleeding, and visual examinations of pregnancy tissue to identify the beginning and end of pregnancy. We compared this to how people use biomedical knowledge such as pregnancy tests, ultrasounds, and clinical examinations to confirm their self-diagnoses. We found that most people felt confident that they could identify the beginning and end of pregnancy through embodied knowledge, especially when combined with the use of home pregnancy tests that confirmed their symptoms, experiences, and visual evidence. All participants concerned about symptoms sought follow-up care at a medical facility, whereas people who felt confident of the successful end of the pregnancy did so less often. These findings have implications for settings of restricted abortion access that have limited options for follow-up care after medication abortion.

International Perspective on Abortion Access for Improving Reproductive Rights and Freedom of Adolescents and Young Adults

International Perspective on Abortion Access for Improving Reproductive Rights and Freedom of Adolescents and Young Adults

Examining ethno-racial attitudes of the public in Twitter discourses related to the United States Supreme Court Dobbs vs. Jackson Women's Health Organization ruling: A machine learning approach.

The decision of the US Supreme Court to repeal Roe vs. Wade sparked significant media attention. Although primarily related to abortion, opinions are divided about how this decision would impact disparities, especially for Black, Indigenous, and people of color. We used advanced natural language processing (NLP) techniques to examine ethno-racial contents in Twitter discourses related to the overturn of Roe vs. Wade. We screened approximately 3 million tweets posted to Roe vs. Wade discussions and identified unique tweets in English-language that had mentions related to race, ethnicity, and racism posted between June 24 and July 10, 2022. We performed lexicon-based sentiment analysis to identify sentiment polarity and the emotions expressed in the Twitter discourse and conducted structural topic modeling to identify and examine latent themes. Of the tweets retrieved, 0.7% (n = 23,044) had mentions related to race, ethnicity, and racism. The overall sentiment polarity was negative (mean = -0.41, SD = 1.48). Approximately 60.0% (n = 12,092) expressed negative sentiments, while 39.0% (n = 81,45) expressed positive sentiments, and 3.0% (n = 619) expressed neutral sentiments. There were 20 latent themes which emerged from the topic model. The predominant topics in the discourses were related to "racial resentment" (topic 2, 11.3%), "human rights" (topic 2, 7.9%), and "socioeconomic disadvantage" (topic 16, 7.4%). Our study demonstrates wide ranging ethno-racial concerns following the reversal of Roe and supports the need for active surveillance of racial and ethnic disparities in abortion access in the post-Roe era.

“A daily reminder of an ugly incident … ”: analysis of debate on rape and incest exceptions in early abortion ban legislation in six states in the southern US

Abortion bans in the United States often include provisions for abortion in the circumstances of rape or incest experience. Such exceptions have been included in important legislation like the Hyde Amendment, 2003 Partial-Birth Abortion Ban Act, 2010 Affordable Care Act, and state and federal legislation banning abortion in early gestation. Thus, examination of these laws is critical given the 2022 Supreme Court decision to devolve legal access to the state level. This study examines arguments made by proponents and opponents of rape and incest exceptions within early abortion ban legislation using publicly available video archives from legislative sessions in six Southern states. A narrative analysis was conducted on the legislative debate of rape and incest exceptions during the 2018–2019 legislative sessions. We found three core themes when examining legislative debate: belief in people’s claims underpinned opposition or support for exceptions; opinions about trauma were related to views on exceptions; and exception supporters called for empathy and non-partisanship in consideration of rape and incest. Additionally, support and opposition for the inclusion of rape and incest exceptions in draft law did not follow party lines. This study seeks to deepen understanding of the strategies used by legislators to promote and rebuff rape and incest exceptions in early abortion legislation while providing greater opportunity for tailored reproductive health, rights, and justice advocacy and policy, especially in the context of the US South where abortion access is now extremely restricted.

Does Proposed Anti-Abortion Legislation Affect Access to Abortion Care? A State-by-State Comparison [ID: 1371679

INTRODUCTION: Concerns over unhindered access to abortion have heightened because of newly proposed state legislation designed to restrict care in the United States. This study examines the effect of such measures on abortion access within each state prior to the 2022 Dobbs v Jackson ruling. METHODS: Proposed anti-abortion measures from 2015 to 2019 were collected from Guttmacher Institute databases, and sorted by state and legislative progress. Rates of abortions during that period were collected from Centers for Disease Control Vital Statistics reports, and similarly sorted by state. Basic statistical analyses were used to compare data. RESULTS: The average ratio of introduced to enacted anti-abortion legislation in the United States was 0.176, with North Dakota having the highest ratio of 1. Average overall abortion rates did not significantly change during this time (9.70 versus 9.44 per 1,000, P=.79). However, the correlation coefficient of state data comparing enacted legislation to overall abortion rates grew in magnitude from −0.189 in 2015 to −0.350 in 2019. The overall percent change in abortion rate per enacted legislation was −0.0089%, with Washington, DC, having the largest at −0.14%. CONCLUSION: Prior to the overturning of Roe v Wade, most state-introduced anti-abortion bills failed to be enacted into law. However, in states legislating restriction, women were disproportionately affected by lack of access to abortion locally. Patients and physicians alike should remain vigilant to the danger posed by anti-abortion legislation that would further hinder access to the reproductive health care of women.

The global impact of COVID-19 on abortion care

BackgroundThe COVID-19 pandemic placed unprecedented strain on healthcare globally, which exacerbated factors leading to unplanned pregnancies. ObjectivesThe primary objective was to analyze the effect of COVID-19 on abortion services globally. Secondary objectives were to discuss issues regarding access to safe abortion and provide recommendations on continued access during pandemics. Search strategyA search for relevant articles was conducted by utilizing multiple databases (PubMed, Cochrane, etc.). Selection criteriaStudies on COVID-19 and abortion were included. Data collection & analysisThe legislation governing abortion services across the globe was examined, inclusive of modifications to service provision during the pandemic. Global data on abortion rates and analyses of selected articles were also included. Main results14 countries instituted legislative changes related to the pandemic, 11 relaxed abortion regulations, while three restricted abortion access. An increase in abortion rates was seen particularly where telemedicine was available. Where abortions were postponed, second-trimester abortions increased after services resumed. ConclusionsLegislation, risk of exposure to infection, and access to telemedicine affect access to abortion. The use of novel technologies, maintaining existing infrastructure and enhancing the roles of trained manpower for safe abortion access is recommended to avoid the marginalization of women's health and reproductive rights.

Fineman Speaks to Dobbs

It is an honor to comment on the scholarship of the preeminent legal theorist Martha Fineman. Throughout her pioneering career, she has challenged liberal feminist ideals grounded in anti-discrimination principles. She shows how sex neutrality and formal equality in law and policy fail to realize justice for women and children. In the last few decades, she has broadened her analysis to a critique of autonomy as a foundational ideal in law. In its place, she offers an account of the state’s obligation to respond to universal human vulnerability. As an entirety, I have found Fineman’s scholarship important to my own work because it offers a formidable normative argument for affirmative entitlements for caregivers and caretaking. Her specific analyses have ranged across diverse socio-legal arenas from divorce law and child custody, to the structure of the workplace, to public assistance and welfare policies.
 In this Essay, I explore the import of Fineman’s ideas for a pressing feminist issue upon which neither of us have focused in our scholarship: abortion. Given her longstanding focus on the social debt owed to mothers (including men who perform the labor of mothering), it is interesting that Fineman has not specifically spoken to the importance of women’s freedom from motherhood. In this Essay, however, I argue her ideas offer a critique of Dobbs v. Jackson Women’s Health Organization and a theoretical foundation for abortion access. I hope this nascent exploration offers new insight into both the range and power of Fineman’s scholarship and productive paths forward for the reproductive justice movement.

The Natural History of Fetal Triploidy in an Era of Limited Abortion Access: A Case Series [ID: 1380133

INTRODUCTION: Triploidy is a chromosomal abnormality that occurs in 1–3% of all conceptions and often results in early spontaneous miscarriage. It is exceedingly rare for a triploid fetus to survive to birth. Neonates usually die within hours to days after delivery. After the Dobbs v Jackson Women's Health Organization ruling in July 2022, access to abortion is becoming increasingly limited, and therefore providers should consider the adverse maternal health outcomes that can be associated with triploidy. METHODS: In this case series, we describe three cases of confirmed fetal triploidy that we encountered in our center within 1 year (2021–2022). All three cases were referred to us after House Bill 1259 was passed on July 1, 2020, in Mississippi banning termination of pregnancy based on race, sex, or genetic abnormality. RESULTS: Our first case is a 21-year-old patient referred at 19 weeks 2 days for abnormal second-trimester serum screen. Ultrasound showed an enlarged multicystic placenta and multiple fetal anomalies. Amniocentesis showed a 69,XXY karyotype. Patient was managed expectantly. At 21 week 5 days, patient was diagnosed with superimposed preeclampsia with severe features. Patient underwent medical termination of pregnancy. The second case is a 25-year-old referred at 30 weeks 0 days for concerns of fetal anomalies. Ultrasound confirmed multiple fetal anomalies. Amniocentesis showed a 69,XXY karyotype. Patient was diagnosed with preeclampsia and pulmonary edema and was delivered at 30 weeks 1 day. The neonate passed away at 22 days of life. Our third case is a 20-year-old referred at 24 weeks 0 days for abnormal aneuploidy screening. Ultrasound showed a major cardiac defect and severe fetal growth restriction. Amniocentesis showed a 69,XXY karyotype. Patient was managed expectantly. At 29 weeks 0 days, intrauterine fetal demise was diagnosed. Patient was diagnosed with peripartum depression. CONCLUSION: Women with pregnancies affected by fetal triploidy are at risk of developing preeclampsia. Restricting access to abortion will lead to increased maternal morbidity and mortality rates.

Identifying abortion access barriers and facilitators for people in prison in Canada

To identify abortion access barriers and facilitators for incarcerated women, trans and nonbinary people in Canada.

Forced Birth and No Time off Work: Abortion Access and Paid Family Leave Policies

Forced Birth and No Time off Work: Abortion Access and Paid Family Leave Policies

Trends in Abortion- and Contraception-Related Internet Searches After the US Supreme Court Overturned Constitutional Abortion Rights

The US Supreme Court ruling in Dobbs v Jackson Women's Health Organization on June 24, 2022, revealed immediate and distinct differences between states regarding abortion legality. Whether the ruling was associated with population-level changes in seeking information on reproductive health care-related information is unknown. To determine whether the US Supreme Court ruling on Dobbs v Jackson Women's Health Organization was associated with increased information seeking for reproductive health care access in the states with immediately effective (trigger and pre-Roe) abortion laws vs other states. This was a retrospective cross-sectional study of nationwide real-time internet search data by state-week from January 1, 2021, through July 16, 2022. Difference-in-difference event study estimates were used to evaluate abortion- and contraception-related internet searches after the Supreme Court draft majority decision was leaked on May 2, 2022, and the final ruling was issued on June 24, 2022, in states immediately affected vs other states. Data analyses were performed from July 18 to January 14, 2022. The Supreme Court's draft majority decision leaked on May 2, 2022, and the final ruling on Dobbs v Jackson Women's Health Organization on June 24, 2022. Preexisting state trigger laws and pre-Roe bans that became effective immediately when Roe was overturned by the decision on Dobbs. Number of searches per 10 million Google queries in a state-week for terms related to abortion or contraception. Searches for abortion-related terms increased from 16 302 to 75 746 per 10 million searches per state-week during the weeks before vs after the May 2, 2022, leak of the draft majority decision in states with trigger laws or abortion bans. This was a 42% (95% CI, 24%-59%) higher increase than in states with laws that protect abortion access. Searches for contraception also increased from 56 055 to 82 133 searches per state-week after the ruling in the states with abortion bans, 25% (95% CI, 13%-36%) higher than the increase in states protecting abortion access. The findings of this retrospective cross-sectional study suggest that changes in internet searching for terms related to reproductive health care can capture immediate population-level changes in information-seeking behavior regarding reproductive health care access. These data are critical for shaping health policy discussions.