Access To Abortion Research Articles

Perceptions of abortion access across the United States prior to the Dobbs v. Jackson Women's Health Organization decision: Results from a national survey.

Abortion is common in the United States (US), although access is becoming more difficult for some. In addition to restrictive policies that ban most abortion, limit the number of providers and increase costs, barriers to access also include less supportive cultural climates and stigma related to abortion. Prior to the Dobbs v. Jackson Women's Health decision of the United States Supreme Court, research suggested that people generally believed it was easy to access abortion, but this research did not examine the underlying factors that drive these perceptions. In 2019, using data from closed and open-ended survey questions, we examined differences in people's assessment of abortion access within the state they reside and factors that influence those perceptions. We recruited English- and Spanish-speaking US adults (N = 2599) from Qualtrics' national panel using quota-based sampling to participate in a web-based survey. We used multinomial logistic regression to examine predictors of access perceptions across demographic characteristics and thematic analysis to analyze open-ended responses. Fifty-three percent of participants believed abortion was easy to access in their state. Spanish speakers and participants from legislatively "hostile" states were more likely to perceive access as difficult. Legality-related knowledge and pro-life identity were associated with perceiving abortion access as easy. Prior to Dobbs, participants' interpretation of the ease or difficulty of accessing abortion were subjective. Misconceptions about state abortion laws and the prevalence of providers were common, suggesting a need for more education about abortion laws, policies, and access.

Separating Procedure-related Fears From Future Fertility Concerns Among a Cohort Seeking Abortion Information Online

IntroductionThe general public and abortion patients in the United States have misinformation about the risks of infertility associated with abortion, which may influence abortion care-seeking. MethodsThe Google Ads Abortion Access Study was a national study of people considering abortion and searching online for information. Participants completed baseline and follow-up surveys, providing free text responses to questions about barriers and facilitators to abortion. We conducted an exploratory analysis of the free text responses related to fertility and used thematic analysis to identify concerns raised about links between abortion and future fertility. ResultsOf 864 participants who provided free text responses in the follow-up survey, 32 specifically mentioned fertility. Few expressed fear that complications from the abortion procedure would somehow lead to infertility; rather, most discussed complex and overlapping thoughts about how abortion factored into their reproductive life plans. These included age-related concerns, missing out on their “chance” to have a child, fear of being punished by God with infertility for having an abortion, and conflicting emotions if they had previously been told they were subfecund or infertile. ConclusionAlthough previous research has focused on misinformation about the link between abortion and infertility, participants in this study rarely mentioned it as a concern. Researchers and practitioners should be attuned to the distinctions people make between infertility occurring as a result of abortion and other fears they might have about not achieving their future reproductive aspirations, ask questions, and provide counseling accordingly.

The New Threat to Abortion Access in the United States—The Comstock Act

This Viewpoint explains the history of the Comstock Act, its use by those seeking to restrict abortion, and why it threatens abortion access in the US.

Political Barriers to Abortion Access in New Brunswick: A Qualitative Exploration of a Political Hot Potato

New Brunswick has been an outlier concerning abortion access for decades. In 2015, the Liberal government under Premier Brian Gallant made significant legislative changes to regulation 84–20 to make abortions more easily accessible in the province. Despite these changes, the Liberal government fell short of publicly funding community-based abortions outside hospitals. This qualitative study aimed to examine the political dynamic and pressures explaining why New Brunswick remains behind on abortion access compared to other Canadian provinces. From September until November 2020, we conducted semi-structured in-depth interviews with 22 participants. Participants were a mix of past and present politicians, health care leaders, and high-ranking public officials identified as key stakeholders in the abortion debate in New Brunswick. Some participants shared their challenges separating their personal views on abortions and admitted wanting to limit access to make it difficult for people to get an abortion. At the same time, other participants described concern for the most vulnerable segments of the New Brunswick population who may struggle with accessing abortions, leading to undue stress and anxiety levels. Ultimately, this article describes the challenges politicians face with power dynamics within their parties and the balance between managing political risks to maintain popularity within the New Brunswick electorate without infringing on people’s right to medical care.

"I mean, I didn't really have a choice of anything:" How incarceration influences abortion decision-making and precludes access in the United States.

To understand how the punitive, rights-limiting, and racially stratified environment of incarceration in the United States (US) shapes the abortion desires, access, and pregnancy experiences of pregnant women, transgender men, and gender non-binary individuals. From May 2018-November 2020, we conducted semi-structured, qualitative interviews with pregnant women in prisons and jails in an abortion supportive and an abortion restrictive state. Interviews explored whether participants considered abortion for this pregnancy; attempted to obtain an abortion in custody; whether and how incarceration affected their thoughts about pregnancy, birth, parenting, and abortion; and options counseling and prenatal care experiences, or lack thereof, in custody. The conditions of incarceration deeply shaped our 39 participants' abortion and pregnancy decisions, with some experiencing pregnancy continuation as punishment. Four themes emerged: (1) medical providers' overt obstruction of desired abortions; (2) participants assuming that incarcerated women had no right to abortion; (3) carceral bureaucracy constraining abortion access; and (4) carceral conditions made women wish they had aborted. Themes were similar in supportive and restrictive states. Incarceration shaped participants' thoughts about pregnancy and their abilities to access abortion, consider whether abortion was an attainable option, and make pregnancy-related decisions. These subtle carceral control aspects presented more frequent barriers to abortion than overt logistical ones. The carceral environment played a more significant role than the state's overall abortion climate in shaping abortion experiences. Incarceration constrains and devalues reproductive wellbeing in punitive ways that are a microcosm of broader forces of reproductive control in US society.

Improving Access and Equity in a Post-Dobbs World

Improving Access and Equity in a Post-Dobbs World

Rebuilding a Reproductive Future Informed by Disability and Reproductive Justice.

Rebuilding a Reproductive Future Informed by Disability and Reproductive Justice.

A Focus on Contraception in the Wake of Dobbs.

A Focus on Contraception in the Wake of Dobbs.

The Challenges in Measurement for Abortion Access and Use in Research Post-Dobbs.

The Challenges in Measurement for Abortion Access and Use in Research Post-Dobbs.

A Nationwide Sample of Adolescents and Young Adults Share Where They Would Go Online for Abortion Information After Dobbs v. Jackson

PurposeGiven the changing landscape of abortion access, we sought to understand where adolescents and young adults retrieve information about abortion online. MethodsA nationwide sample (n = 638) of 14- to 24-year-olds responded to a qualitative text message survey in July 2022 regarding websites or social media they would use for abortion-related information. Open-ended responses were coded and analyzed for themes. ResultsForty-six percent of respondents (n = 234) named specific websites or accounts of known organizations or individuals; 14% named general clinical or governmental resources; and 13% named social media platforms. Eight percent expressed skeptical sentiments about online abortion information. 17% (n = 99) said they were not sure or did not have an opinion. DiscussionMany adolescents and young adults could name an online resource for abortion information, but some are not aware of specific resources, underscoring a need to elevate reputable sources and provide guidance on how and where to look for accurate online abortion-related information.

Main barriers to services linked to voluntary pregnancy termination on three grounds in Chile.

After decades of absolute criminalization, on September 14, 2017, Chile decriminalized voluntary termination of pregnancy (VTP) when there is a life risk to the pregnant woman, lethal incompatibility of the embryo or fetus of genetic or chromosomal nature, and pregnancy due to rape. The implementation of the law reveals multiple barriers hindering access to the services provided by the law. To identify and analyze, using the Tanahashi Model, the main barriers to the implementation of law 21,030 in public health institutions. This article contributes to the follow-up of this public policy, making visible the obstacles that violate women's rights of women to have dignified access to abortion and that affect the quality of health care in Chile. Qualitative design, following the postpositivist paradigm. The sample consisted of relevant actors directly related to pregnancy termination. Snowball sampling and semi-structured interviews were used. Grounded theory was used through inductive coding, originating categories regrouped into meta-categories following Tanahashi's model. The rigor criteria of transferability, dependability, credibility, authenticity, and epistemological theoretical adequacy were used. The identity of the participants and the confidentiality of the information were protected. From January 2021 to October 2022, 62 interviews were conducted with 20 members of the psychosocial support team; 18 managers; 17 members of the biomedical health team; 4 participants from of civil society, and three women users. The main obstacles correspond to availability barriers, accessibility barriers, acceptability barriers, contact barriers, and effectiveness barriers. Barriers to access abortion under three grounds violate the exercise of women's sexual and reproductive rights. It is urgent to carry out actions of control and follow-up of this public policy to the corresponding entities.

The difficult process of autonomous choice: using I-poems to understand experiences of abortion-seekers in The Netherlands

While key barriers to abortion care accessibility have been established, little is known about the experiences of people having abortions in the Netherlands. Stories of individual abortion-seekers can help counteract stereotyping, diminish abortion stigma, and improve accessibility. This study’s research question is: What experiences do abortion-seekers in the Netherlands have with abortion care and what new insights can the I-poem method of analysis provide? This qualitative feminist study used transcripts of semi-structured, in-depth interviews with abortion-seekers from previous research to create I-poems. Using a grounded theory method, the I-poems were coded deductively to validate previous findings, and inductively to generate new insights. The I-poems revealed that although abortion-seekers felt autonomous, their decision-making was complicated by doubt concerning their partner’s views and/or suitability as a parent, feelings of shame, and a lack of support. The abortion-seekers were often slowed by obstacles in policy and care; waiting caused feelings of fear and panic and routine pre-abortion ultrasounds led to anxiety. They often did not know what to expect from their body or the abortion procedure. I-poems show how autonomous choice in abortion care is socially constructed rather than purely individual. Abortion providers must pay special attention to external factors complicating the decision-making process such as partner discordance (even in stable relationships) and anxiety due to waiting times and routine pre-abortion ultrasound. Future action on normalisation of information provided on all aspects of choosing an abortion is necessary to realise informed choice and reduction of abortion stigma. Plain language summary Abortion is a medical procedure that ends a pregnancy. In some countries, people can easily get an abortion. In others, it is illegal or difficult to access. In the Netherlands, abortion is accessible and legal before 24 weeks of pregnancy and can be performed upon request of the abortion seeker. This policy is often seen as liberal, as it allows people to make their own decisions about their bodies. Still, abortion stigma is present in Dutch society. Stigma around abortion refers to negative attitudes and beliefs that society has towards people who have had abortions or are considering having one. Research by Holten et al 7 looked at how easy it is for abortion seekers in the Netherlands to access abortion services. The study highlighted that people in the Netherlands still face barriers to accessing abortion services. For example: the law and regulations regarding abortions and the fact that people had difficulty in talking about their abortion due to stigma. The abovementioned study gives a broad view on challenges in the accessibility of abortion in the Netherlands, but the individual experiences are not portrayed. The goal of this study is to learn about the personal experiences of abortion-seekers in the Netherlands. It aims to understand what it’s like for these people to access abortion services and what we can learn from their individual stories by using a method of analysis called I-poem. I-poems are a type of poem created by the researcher by looking for sentences using the first-person pronoun “I” in interview texts. I poems show the personal experience or point of view of the person interviewed. This type of poem is often used to express emotions or share personal stories or observations. This study used interviews with people who have had abortions to create I-poems. The grounded theory method was used to analyse the I-poems in two ways: confirming what was found in previous studies, and also providing new insights from the data. The study found that the people contemplating having an abortion had a hard time making the decision to have an abortion because they had doubts, were worried about what their partner would think, felt ashamed to talk about it with friends and family, and didn’t have enough support. They also faced challenges like having to wait for the abortion because of clinic schedules and laws and getting ultrasounds before the procedure, which made them anxious. It was also found that the people contemplating abortion were unsure of what to expect from the abortion procedure and how their body would react, which made the decision even harder. The study concludes that even when people felt in control of their decision, the decision-making process was still difficult. The decision is not just personal, but is also affected by society, partners, and healthcare policies. The waiting time and the ultrasound before the abortion made the process harder, and abortion seekers were not aware of what to expect from the procedure. More information and education on all aspects of having an abortion should be provided to help people to make better informed decisions and reduce the abortion stigma. Further research on experiences of routine ultrasound before abortion in the Netherlands is needed to improve abortion care.

Transient rise in medical abortions at Michigan clinic during SARS-CoV-2 “stay-at-home” order

Background In response to the SARS-CoV-2 (COVID-19) pandemic, the State of Michigan enacted a “stay-at-home” executive order detailing social distancing guidelines on March 24, 2020, with an expiration date of June 1, 2020. Objectives Given that medical abortions allow for pregnancy tissue to be passed in the privacy of one’s home, the authors hypothesized that there would be an increase in medical abortions over first trimester surgical abortions in 2020 compared to 2019 due to social distancing guidelines. Study Design Retrospective data was collected from an abortion clinic in Southeastern Michigan between January 1, 2019 and December 31, 2020 (n=4,703). A negative binomial statistical model compared the number of medical abortions in 2019 to 2020. Each year was divided into quartile (Q) periods of three consecutive months. Analysis focused on the frequency and percentage of medical abortions in 2020 compared to 2019, with a focus on the relationship between quartiles. Results Medical abortions increased from a count of 702 in 2019, to 979 in 2020 (p-value=0.00499). There were statistically significant differences between 2019 and 2020 for Q2 (31.47% to 40.89%, p-value<0.001) and Q3 (33.15% to 53.70%, p-value<0.001), as well as a return-to-baseline in Q4, which is demonstrated by pre-executive order 2020 Q1 at 33.91% and post-executive order 2020 Q4 at 37.19%. Conclusions Statistically significant differences between 2019 and 2020 for Q2 and Q3 support the hypothesis that an increase in preference towards medical abortions over surgical abortions coincided with Michigan’s stay-at-home mandates; it was further supported by insignificant differences in 2019 and 2020 for Q1 and Q4. Understanding trends in patient choices for abortion access provides vital information for policymakers and healthcare providers to expand medical abortion care using remote options.

Abortion Access in the United States: A View on the Ground

Abortion Access in the United States: A View on the Ground

Ethical research when abortion access is legally restricted.

Risks and benefits of some clinical research may be altered.

Abortion care availability, readiness, and access: linking population and health facility data in Kinshasa and Kongo Central, DRC

BackgroundThe Democratic Republic of Congo (DRC) legalized abortion in 2018 to preserve health and pledged to provide quality postabortion care (PAC), yet little is known about the availability of abortion care services and if facilities are prepared to provide them; even less is known about the accessibility of these services. Using facility and population-based data in Kinshasa and Kongo Central, this study examined the availability of abortion services, readiness of facilities to provide them, and inequities in access.MethodsData on 153 facilities from the 2017–2018 DRC Demographic and Health Survey Service Provision Assessment (SPA) were used to examine signal functions and readiness of facilities to provide services across three abortion care domains (termination of pregnancy, basic treatment of abortion complications, and comprehensive treatment of abortion complications). To examine PAC and medication abortion provision before and after abortion decriminalization, we compared estimates from the 2017–2018 SPA facilities to estimates from the Performance Monitoring for Action (PMA) data collected in 2021 (n = 388). Lastly, we assessed proximity to PAC and medication abortion using PMA by geospatially linking facilities to representative samples of 2,326 and 1,856 women in Kinshasa and Kongo Central, respectively.ResultsFew facilities had all the signal functions under each abortion care domain, but most facilities had many of the signal functions: overall readiness scores were > 60% for each domain. In general, readiness was higher among referral facilities compared to primary facilities. The main barriers to facility readiness were stock shortages of misoprostol, injectable antibiotics, and contraception. Overall, provision of services was higher post-decriminalization. Access to facilities providing PAC and medication abortion was almost universal in urban Kinshasa, but patterns in rural Kongo Central showed a positive association with education attainment and wealth.ConclusionMost facilities had many of the necessary signal functions to provide abortion services, but the majority experienced challenges with commodity availability. Inequities in accessibility of services also existed. Interventions that address supply chain challenges may improve facility readiness to provide abortion care services, and further efforts are needed to narrow the gap in accessibility, especially among poor women from rural settings.

Alcohol-involved rape: Limitations of the "rape exception" for abortion access.

In June 2022, the U.S. Supreme Court removed federal abortion protections, giving individual states the authority to enact abortion regulations. Since that ruling, many states have enacted abortion bans; however, several of these states allow "rape exceptions," theoretically providing rape victims who become pregnant access to abortion services. Notably, alcohol use by the rape victim and perpetrator is common. In this brief report, we describe findings from research on alcohol-involved rape that have the potential to impact the utility of rape exceptions. In this synthesis of the research literature pertaining to alcohol-involved rape victimization and perpetration, we focus on key concepts detailed in extant research likely relevant to accessing abortion services through rape exceptions. Victim alcohol intoxication may limit the use of rape exceptions to abortion bans by delaying rape acknowledgment, increasing victim blame, undermining victim credibility, and deterring rape reporting. Commensurately, perpetrator alcohol intoxication may increase the need for victims to access abortion services by reducing perpetrator condom use during rape and increasing other sexually aggressive acts such as nonconsensual condom removal. Research evidence suggests that alcohol-involved rape incidents present critical obstacles to utilizing statutory rape exceptions to banned abortion services beyond challenges that non-alcohol-involved rape survivors are also likely to experience. Rape survivors from oppressed communities (e.g., people of color, gender minorities, and/or sexual minorities) may be disproportionately impacted. Empirical investigations specifically examining how substance use during rape impacts reproductive health care accessibility are paramount for informing health care providers, law enforcement, legal practitioners, and policymakers. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Stigma towards women requesting abortion and association with health facility staff facilitation and obstruction of abortion care in South Africa.

Abortion stigma has been shown to influence provider attitudes around abortion and may decrease provider willingness to participate in abortion care, or lead some to obstruct care. However, this link remains understudied. The present study uses baseline data collected through a cluster-randomized controlled trial in 16 public sector health facilities in South Africa in 2020. A total of 279 clinical and non-clinical health facility workers were surveyed. Primary outcome measures included: 1) willingness to facilitate abortion care in eight hypothetical scenarios, 2) facilitation of abortion care in the last 30 days, and 3) obstruction of abortion care in the last 30 days. Logistic regression models were used to assess the association between level of stigma as measured through the Stigmatizing Attitudes, Beliefs and Actions Scale (SABAS) and the primary outcomes. Overall, 50% of respondents in the sample were willing to facilitate abortion care in each of the eight scenarios, with differences in willingness based on the abortion client's age and personal situation in each scenario. Over 90% reported facilitating abortion care in the last 30 days, but 31% also reported having obstructed abortion care in the last 30 days. Stigma was significantly associated with willingness to facilitate abortion care and actual obstruction of abortion care in the last 30 days. Controlling for covariates, odds of willingness to facilitate abortion care in every scenario decreased with every one-point increase in SABAS score (reflecting more stigmatizing attitudes), and odds of obstructing abortion care increased with every one-point increase in SABAS score. Lower abortion stigma on the part of health facility workers was associated with willingness to facilitate abortion access but not actual facilitation of abortion services. Higher abortion stigma was associated with actual obstruction of an abortion service in the last 30 days. Interventions to reduce stigma towards women seeking abortion, and particularly negative stereotyping, among all health facility staff is key to ensuring equitable and non-discriminatory access to abortion. Retrospectively registered on clinicaltrials.gov (ID: NCT04290832) on February 27, 2020. The link between stigma against women seeking abortion and decisions around whether to provide, abstain, or obstruct abortion care remains understudied. This paper assesses how stigmatizing beliefs and attitudes towards women seeking abortion in South Africa affects willingness to facilitate abortion care and actual facilitation or obstruction of abortion care in practice. A total of 279 clinical and non-clinical health facility workers were surveyed between February and March 2020. Overall, half of respondents in the sample were willing to facilitate abortion care in each of the eight scenarios, with important differences in willingness by scenario. Almost all respondents reported facilitating an abortion procedure in the last 30 days, but one in three also reported having obstructed abortion care in the last 30 days. More stigmatizing attitudes corresponded to decreased willingness to provide abortion care and increased odds of obstructing abortion care. Results show that stigmatizing attitudes, beliefs, and actions toward women who seek abortion shape how clinical and non-clinical staff in South Africa feel about their participation in abortion services and whether they obstruct this care. Facility staff hold great power in determining whose abortions are facilitated and whose are obstructed, resulting in stigma and discrimination being openly perpetuated. Continuous work to reduce stigma towards women seeking abortion among all health workers is key to ensuring equitable and non-discriminatory access to abortion for all.

Self-managed medication abortion: What nurse practitioners need to know

Given the evolving legal landscape of abortion access in the United States, the author discusses what nurse practitioners should know about their legal considerations and how to keep patients seeking their care safe when they undergo self-managed medication abortion.

Systemic delays to abortion access undermine the health and rights of abortion seekers across Australia.

Systemic delays to abortion access undermine the health and rights of abortion seekers across Australia.