Availability Of Abortion Services Research Articles

Explaining withdrawal’s persistence: correlates of withdrawal use in Albania, Armenia, Jordan, and Turkey observed in a cross-sectional study

Background: Withdrawal dominates the contraceptive method mix in a geographical cluster of countries in South-Eastern Europe and Western Asia that have, in part, reached low fertility. This study examines the socio-demographic determinants associated with withdrawal use in Armenia, Albania, Jordan and Turkey that could explain withdrawal’s persistence and inform contraceptive programs in these unique settings. Methods: Cross-sectional data on 31,569 married women 15 to 49 years were drawn from the Demographic and Health Surveys in Albania (2017-2018), Armenia (2015-2016), Jordan (2017-2018), and Turkey (2013). For each country, multinomial regression models estimating withdrawal use among all women and logistic regression models estimating withdrawal use among contraceptive users were used to evaluate the association with age, marital duration, parity, education, residence, and household wealth. Results: The socio-demographic determinants associated with withdrawal use varied by country among all women and among all contraceptive users. While these associations were not all significant for all four countries general trends included that women were more likely to use withdrawal than not use contraception, but less likely to use withdrawal than other methods with increasing parity, higher education, and greater household wealth. Measures of association are reported by country for each correlate. Conclusions: Despite the similar contraceptive mix in these four countries, no single set of factors was found to explain withdrawal’s persistence. Withdrawal’s prevalence in this geographical cluster may instead result from different balances of intertwined circumstances that include couples’ fertility decisions, access to modern contraception and availability of abortion services.

Explaining withdrawal’s persistence: correlates of withdrawal use in Albania, Armenia, Jordan, and Turkey observed in a cross-sectional study

Background: Withdrawal dominates the contraceptive method mix in a geographical cluster of countries in South-Eastern Europe and Western Asia that have, in part, reached low fertility. This study examines the socio-demographic determinants associated with withdrawal use in Armenia, Albania, Jordan and Turkey that could explain withdrawal's persistence and inform contraceptive programs in these unique settings. Methods: Cross-sectional data on 31,569 married women 15 to 49 years were drawn from the Demographic and Health Surveys in Albania (2017-2018), Armenia (2015-2016), Jordan (2017-2018), and Turkey (2013). For each country, multinomial regression models estimating withdrawal use among all women and logistic regression models estimating withdrawal use among contraceptive users were used to evaluate the association with age, marital duration, parity, education, residence, and household wealth. Results: The socio-demographic determinants associated with withdrawal use varied by country among all women and among all contraceptive users. While these associations were not all significant for all four countries general trends included that women were more likely to use withdrawal than not use contraception, but less likely to use withdrawal than other methods with increasing parity, higher education, and greater household wealth. Measures of association are reported by country for each correlate. Conclusions: Despite the similar contraceptive mix in these four countries, no single set of factors was found to explain withdrawal's persistence. Withdrawal's prevalence in this geographical cluster may instead result from different balances of intertwined circumstances that include couples' fertility decisions, access to modern contraception and availability of abortion services.

Exploring the availability of abortion services at Canadian hospitals: a mystery client study

Exploring the availability of abortion services at Canadian hospitals: a mystery client study

Abortion Facility Closings and Abortion Rates in Texas.

From 2004 to 2014, the overall abortion rate in Texas fell by almost a third from 10.7 to 7.2 abortions per 1000 women aged 10 to 49 years. During this same period, the number of abortion clinics operating at least 6 months in the year fell from 40 to 27. We examined the relationship between the abortion rate and the proximity of abortion facilities. We matched annual, county-level data on abortion rates in Texas from 2004 through 2014 with the distance from the county centroids to the nearest abortion facility in operation. Linear regressions were used to estimate the association between abortion rates and proximity to abortion facilities. The regressions controlled for county-level and state-level characteristics as well as the availability of abortion services in neighboring US states and Mexico. We found that a 100-mile increase in distance to the nearest abortion facility was associated with a 10% decrease in the overall abortion rate. The relationship appeared to be driven largely by distances of 200 miles or more. The overall relationship was generally present for whites and blacks, whereas the pattern was less clear for Hispanics. The analysis indicated that the overall association was driven largely by women aged 20 to 34 years. Decreased access to abortion facilities was associated with decreases in the abortion rate, yet the relationship varied by race/ethnicity and age. As such, regulations that affect the operational status of abortion facilities likely have differential effects on women.

Availability and distribution of safe abortion services in rural areas: a facility assessment study in Madhya Pradesh, India

BackgroundUnsafe abortion contributes to a significant portion of maternal mortality in India. Access to safe abortion care is known to reduce maternal mortality. Availability and distribution of abortion care facilities can influence women's access to these services, especially in rural areas.ObjectivesTo assess the availability and distribution of abortion care at facilities providing childbirth care in three districts of Madhya Pradesh (MP) province of India.DesignThree socio demographically heterogeneous districts of MP were selected for this study. Facilities conducting at least 10 deliveries a month were surveyed to assess availability and provision of abortion services using UN signal functions for emergency obstetric care. Geographical Information System was used for visualisation of the distribution of facilities.ResultsThe three districts had 99 facilities that conducted >10 deliveries a month: 74 in public and 25 in private sector. Overall, 48% of facilities reported an ability to provide safe surgical abortion service. Of public centres, 32% reported the ability compared to 100% among private centres while 18% of public centres and 77% of private centres had performed an abortion in the last 3 months. The availability of abortion services was higher at higher facility levels with better equipped and skilled personnel availability, in urban areas and in private sector facilities.ConclusionsFindings showed that availability of safe abortion care is limited especially in rural areas. More emphasis on providing safe abortion services, particularly at primary care level, is important to more significantly dent maternal mortality in India.

Behind-the-Counter, But Over-the-Border? The Assessment of the Spillover Effect of Increased Availability of Emergency Contraception in Washington on Neighboring States

Washington was the first state to ease the prescription requirements making emergency contraception (EC) available behind-the-counter at pharmacies to women of any age in 1998. I hypothesize that the increased availability of EC affects fertility rates beyond the borders of the state that allows it. In contrast to the literature, I show that increased access to EC is associated with a statistically significant albeit economically small decrease in abortion rates in Washington counties where women had access to no-prescription EC pharmacies. Yet, there is no effect on pregnancy rates. These results are robust in a number of specifications. Finally, I find some evidence in support of the spillover effects in Idaho, but not Oregon. However, after accounting for changes in the availability of abortion services, the decrease in fertility rates in treated Idaho counties is rather small and models lack sufficient power to detect it.

Understanding Health Care in the 2012 Election

The outcome of the 2012 election will have far-reaching ramifications for the future of U.S. health care. Rarely in a national election have the two major candidates' views about health care been so diametrically opposed. The views of President Barack Obama and Republican presidential nominee Mitt Romney differ on whether the 2010 Affordable Care Act (ACA) should be implemented or repealed, whether Medicare and Medicaid should remain in their current forms with their current level of commitments, and whether the availability of abortion services should be further restricted. In addition, the candidates differ on whether the historically high federal budget . . .

Overview of the law and availability of abortion services in Ghana

In Ghana unsafe abortion remains a major public health problem despite apparent liberalization of the law on abortion over two decades. The contention is that the current law on abortion makes enforceability difficult and leaves room for untrained personnel to engage in dangerous abortion procedures and that there is need for law reform. To bring into focus how the current law affects the availability of safe abortion service in Ghana and to bring out suggestions that may be useful in future amendment of the law. Using the information gathered from literature review the current law on abortion in Ghana and relevant sections of the criminal code were critically analyzed from medico-legal perspective. Since 1985 the Ghanaian law on abortion has changed from its preoccupation with prohibition and punishment towards liberalization of abortion but there has been delay in policy formulation and implementation to translate the law into services. Hence safe abortion services on medico-social grounds as permitted by the law are not readily available in national health institutions. Some aspects of the law still appear implicit and may hamper implementation of safe abortion service in the country. For clarity there is need for more amendments in the law in order to regulate abortion and to enhance the right of the woman to make a choice on her own. There is also the need to expedite action on development policy and standard guidelines for practitioners.

Incarcerated women and abortion provision: a survey of correctional health providers.

Many women entering jail or prison are pregnant, and correctional facilities are therefore an important venue for providing a range of pregnancy-related care, including access to abortion services. However, the availability of abortion services to inmates in the United States is unknown. Between October 2006 and March 2007, surveys about abortion provision were mailed to 951 health professionals who provided clinical care in correctional facilities. Descriptive statistics were tabulated, and measures of association were calculated using chi-square analysis. Of the 286 respondents who returned analyzable surveys, 68% indicated that inmates at their facility can obtain "elective" abortions. Eighty-eight percent of this group indicated that their facility provides transportation, but only 54% said that they help arrange appointments. Responses did not differ by providers' individual or institutional characteristics. However, providers from states with a Republican-dominated legislature or with a Medicaid policy that severely restricted coverage for abortion were more likely to indicate that availability of abortion services was limited than were those whose state had a predominantly Democratic legislature or a Medicaid program that covered all or most medically necessary abortions. Although incarceration does not preclude women's need for access to abortion, full access to services is not available in all settings. Improving women's overall health care in correctional settings should include increasing the accessibility of abortion services.

The Role of Advanced Practice Clinicians in the Availability of Abortion Services in the United States

Although abortion is one of the most common surgical procedures performed in the United States, the number of abortion providers is declining. Advanced practice clinicians, including nurse practitioners and certified nurse-midwives, may help to alleviate this shortage. However, some states bar nonphysicians from performing abortions. Not only should training in abortion techniques be made available to nonphysician providers who desire it, but legal obstacles must also be overcome in order to allow advanced practice clinicians the right to provide abortion services.

Accessibility and availability of abortion in six European countries

Objectives The accessibility and availability of abortion are a reflection of abortion law and the accessibility and availability of abortion services. Experiences from six European countries with different political, cultural, social and religious backgrounds (the Netherlands, France, Great Britain, Slovenia, Hungary and Turkey) are presented.Results Abortion laws in Europe range from complete prohibition to complete liberalization of abortion. Some countries demand a waiting period for the procedure, pre-abortion counseling, parental approval for minors, and in the others there are no mandatory requirements. Abortions are generally performed in authorized facilities by gynecologists or general practitioners. Abortion services are easily accessible, in terms of the law, availability of facilities and health insurance coverage of the procedure in the Netherlands, France and Slovenia. Abortion service is less accessible in United Kingdom, Hungary and Turkey, as a result of limited accessibility to abortion services or a relatively high abortion fee. In some Eastern European countries there has been a tendency in the last decade to limit the availability and access to abortion.Conclusions In Europe abortion is generally well accessible in terms of abortion laws. There are differences in accessibility to abortion services between the countries, and in some countries, also between different areas of the country.

Estimating the factors determining the demand for induced abortions among married women in Taiwan

This paper purports to estimate the characteristics of women who had experiences of abortion in 1991 based on an economic model of fertility. The study makes use of a national survey on the knowledge of, attitude towards, and practice of family planning and reproductive health among married women in Taiwan. The results show that older women with higher family income and who live in urban areas were more likely to have the pregnancy terminated. In addition, the decision to have an abortion was negatively correlated with prior pregnancy loss, but positively associated with the number of previous live births. On the other hand, the availability of abortion services as measured by the number of legal abortion providers at city and county levels had a negative effect on the demand for abortions. The local female unemployment rate was found to be positively correlated with the woman's decision to have an abortion.

An economic analysis of abortion: the effect of travel cost on teenagers

This paper estimates the responsiveness of abortion demand among teenage women to variations in the local availability of abortion services. This information is especially important because the policy debate centers on how restricting the availability of abortion services will affect abortion rates. In addition, it is commonly thought that teenage and adult women differ in the abortion decision process, making it necessary to evaluate teens separately from adults. Data from the state of Texas, where abortion is available in 19 of 254 counties, allow for approximating county-level variations in the travel cost of acquiring an abortion. The results suggest that abortion rates of teenage women 13 to 17 years of age are sensitive to variations in travel cost. Counties in which teenage women must travel longer distances to obtain an abortion have lower abortion rates both per woman and per pregnancy. In addition, a comparison of teenage women and all women of childbearing age shows characteristic differences in the quantitative effects of travel cost and other socioeconomic variables.

The implications of current policies on the production of infant health

This study examines the possible link between the current trend to reduce availability of abortion services and the incidence of low birthweight births. Using current data on births and abortions in Atlanta and New York City, we update and expand the earlier empirical results of Grossman and Joyce (The Journal of Political Economy, 1990, 98 (5), 98-1007). Using their latent variable model framework, we find some evidence for the ‘cost of abortion’ model, which assumes that increasing the full costs of abortion will be associated with more low birthweight, hence less healthy, infants. These results indicate that current trends towards the reduction of funding for various social services could exacerbate the problem of low birthweight.

Family Planning Service Provision in Rural Areas: A Survey in Washington State

Women in rural areas are highly dependent on public clinics for family planning services, yet little information has been collected on rural family planning providers, especially on their funding and operation. All 31 family planning clinic sites in rural Washington State were surveyed about their sponsorship, staffing, service provision and population coverage. Clinic sites were located in 25 of the 53 discrete rural health service areas of Washington State. While the three wealthiest areas had clinics, eight of the poorest areas had no clinics. Eight clinics were Planned Parenthood affiliates, eight were private freestanding clinics and 15 were local health department sites. Clinic sites were small (with the equivalent of 2.4 full-time staff members, on average) and offered a mean of 18 of 43 potential reproductive and women's health care services; general primary care services were rarely provided. Only one clinic offered abortions. Family planning clinics in rural Washington State offer an important but limited number of services. Many rural areas have no local family planning clinic. Given these clinics' reliance on federal and state funding, decreased public support might seriously impair family planning provision in rural areas.

The Impact of Mississippi's Mandatory Delay Law on Abortions and Births

Beginning August 8, 1992, a woman in the state of Mississippi had to wait 24 hours after in-person receipt of state-mandated information regarding abortion and birth complications, fetal development, and alternatives to abortion before an abortion could be performed. To analyze the effect of the law on the abortion and birth rates of Mississippi residents. A retrospective analysis of abortion and birth rates before and after the law in Mississippi as contrasted with abortion and birth rates in 2 comparison states, Georgia and South Carolina. Neither Georgia nor South Carolina enforced a mandatory delay law, but both states began enforcement of parental notification statutes during the study period. Female residents of reproductive age in Mississippi, Georgia, and South Carolina between 1989 and 1994. We compared birth rates, abortion rates, the percentage of late abortions, and the percentage of abortions performed outside the state of residence for all women and then by age and race before and after August 1992 among women of Mississippi, Georgia, and South Carolina. We found that rate ratios (RRs) of resident abortion rates (rate after law implementation/rate before law implementation) declined 12% more in Mississippi than in South Carolina (95% confidence interval [CI], 8%-15%) and 14% more in Mississippi than in Georgia (95% CI, 10%-17%) in the 12 months after the law went into effect. Rate ratios for white adults declined 22% more in Mississippi than in South Carolina (95% CI, 17%-27%) and 20% more in Mississippi than in Georgia (95% CI, 15%-25%). Changes among nonwhite adults and white teens were more modest but also statistically significant (P<.05). For all women, RRs of the percentage of abortions performed after 12 weeks' gestation increased 39% more in Mississippi than in either South Carolina or Georgia (P<.05); the increase in the percentage of abortions after 12 weeks' gestation was observed for white and non-white adults (P<.05). We also show that the percentage of abortions performed out of state increased 42% more among women in Mississippi relative to women in South Carolina after the law (95% CI, 34%-50%). The timing of the decline in abortion rates in Mississippi, the lack of similar declines in comparison states, the rise in percentage of late abortions and abortions performed out of state and the apparent completeness of abortion reports suggest that Mississippi's mandatory delay statute was responsible for a decline in abortion rates and an increase in abortions performed later in pregnancy among residents of Mississippi. The effect of delay laws in other states will likely depend on whether statutes require 2 separate visits to the abortion provider (ie, clinics, hospitals, or physicians' offices where abortions are performed) and the availability of abortion services.

State abortion policy and infant health: A simulation model of the impact of hypothetical patterns of state laws proscribing abortion services

Prior research suggests that the availability of abortion services may affect the proportion of observed births with poor outcomes (e.g., low birth weight). Recent Supreme Court decisions and changes in the composition of elected officials of state governments have increased the saliency of state discretion over abortion related policies. This paper presents results from a simulation model of the effects of hypothetical state laws prohibiting abortion on observed measures of infant health in the states regarded as most likely to adopt laws significantly restricting abortion access. Under several model scenarios, both the incidence of low birthweight infants and neonatal mortality among blacks are predicted to increase substantially in states adopting restrictive abortion laws. The predicted impact among whites, however, is relatively small.

Propuesta de un método para estimar la, subnotificación del aborto inducido practicado en españa

In Spain, from 1987 to 1990 the rate of legal abortion reported to the health authorities has doubled; nevertheless, the observed geographical differences suggest to an underreporting of the number of voluntary pregnancy terminations. Based on information on several sociodemographic, economic and cultural characteristics, contraceptive use, availability of abortion services, fertility indices, and maternal and child health status, five homogenEous groups of autonomous region were identified applying factor and cluster analysis techniques. To estimate the level of underreporting, we assumed that all the regions which shape a cluster ought to have the same abortion rate that the region with the highest rate in each group. We estimate that about 18,463 abortions (33.2%) were not reported during 1990. The proposed method can be used for assessing the notification since it allows to identify geographical areas where very similar rates of legal abortion are expected.

Effects of price and availability on abortion demand.

Over 1.5 million legal abortions were performed in the United States in 1988. State‐level regulation affecting the price or availability of abortion services may expand given recent Supreme Court decisions. This paper uses state‐level data pooled over time to estimate abortion demand. Using single cross‐sections of state data, past studies find abortion demand per 1,000 pregnancies to be price inelastic and find income elasticity to be positive and significant. The analysis here shows that price elasticity estimates in a single cross‐section are sensitive to the choice of state characteristics used to control for “abortion attitudes” within a state. Ajixed‐efects model design with pooled data gives more robust abortion demand price elasticity estimates. The results suggest that any new state regulations that increase the costs of obtaining abortions will reduce abortion use and increase unintended fertility.

Teenage conception and contraception in the English regions

Nationally available data on teenage fertility, family planning care and mortality were analysed to determine the relationship between teenage conception, availability of abortion and family planning care, and an indicator of socioeconomic disadvantage--the Standardized Mortality Ratio (SMR). In the 14 regions of England the strongest correlate of teenage conception and of the proportion of teenage conceptions aborted was female all-causes SMR. High levels of provision of NHS abortion services and uptake of family planning clinic care did not significantly reduce teenage fertility. Provision of traditional family planning services obviously plays an important role in preventing teenage pregnancy, but innovation in this service coupled with a concerted effort to reduce social disadvantage might have a greater impact on teenage fertility in England.