Legal Abortion Research Articles

Impact of Dobbs v. Jackson Women’s Health Organization on Professional Decision-Making Among Urology Applicants

The effect of the Dobbs decision on 2023 Urology match applicants: 88% disapproved, and 1/5 eliminated programs from their rank list.[MeSH = “urology”, “abortion, induced”, “reproductive health”/ “reproductive health services”, “workforce”/ “health workforce”, “internship and residency”/ “medical residency”] ObjectiveTo examine the impact of the 2022 U.S. Supreme Court ruling Dobbs v. Jackson Women’s Health Organization, which declared there is no constitutional right to abortion, on professional decision-making in residency selection and ranking. Materials and MethodsAn IRB-exempt REDCap survey was distributed through the Society of Academic Urologists to all 508 applicants registered for the 2023 Urology Match following the rank list submission deadline on January 10, 2023. The survey closed on February 1, 2023. Responses were anonymized, aggregated, and characterized using descriptive statistics. Thematic mapping of open text comments was performed by two reviewers. ResultsThe response rate was 42% (215/508). 88% of respondents disapproved of the Dobbs ruling. Twenty percent of respondents (15% male/24% female) eliminated programs in states where abortion is illegal. Fifty nine percent (51% male/70% female) would be concerned for their or their partner’s health if they matched in a state where abortion was illegal, and 66% (55% male/82% female) would want their program to assist them or their partner if they required abortion care during residency. Due to the competitive nature of Urology, 68% of applicants reported feeling at least somewhat obligated to apply in states where abortion legislation conflicts with their beliefs. Of the 65 comments provided by respondents, four common themes emerged: 1) Avoidance of states with restrictive abortion laws; 2) Inability to limit applications because of the competitiveness of urology; 3) Impacts on personal healthcare; and 4) Desire for advocacy from professional urology organizations. ConclusionsThe Dobbs ruling will impact the urology workforce by affecting urology applicants’ decision-making regarding residency selection and ranking. Although the competitiveness of the Urology Match pressures applicants to apply broadly, many are taking reproductive healthcare access into consideration.

Striving towardsafe abortion services in Nepal: A review of barriers and facilitators.

Despite the decriminalization of abortion in Nepal in 2002, unsafe abortion is still a significant contributor to maternal morbidity and mortality. Nepal has witnessed a significant drop in abortion-related severe complications and maternal deaths owing to the legalization of abortion laws, lowered financial costs, and wider accessibility of safe abortion services (SAS). However, various factors such as sociocultural beliefs, financial constraints, geographical difficulties, and stigma act as barriers to the liberal accessibility of SAS. This review aimed to determine key barriers obstructing women's access to lawful, safe abortion care and identify facilitators that have improved access to and quality of abortion services. A systematic search strategy utilizing the databases PubMed, CINAHL, Scopus, and Embase was used to include studies on the accessibility and safety of abortion services in Nepal. Data were extracted from included studies through close reading. Barriers and facilitators were then categorized into various themes and analyzed. Of 223 studies, 112 were duplicates, 73 did not meet the inclusion criteria, and 18 did not align with the research question; thus, 20 studies were included in the review. Various barriers to SAS in Nepal were categorized as economic, geographic, societal, legal/policy, socio-cultural, health systems, and other factors. Facilitators improving access were categorized as economic/geographic/societal, legal/policy, socio-cultural, and health systems factors. The patterns and trends of barriers and facilitators were analyzed, grouping them under legal/policy, socio-cultural, geographic/accessibility, and health systems factors. The review identifies financial constraints, unfavorable geography, lack of infrastructure, and social stigmatization as major barriers to SAS. Economics and geography, legalization, improved access, reduced cost and active involvement of auxiliary nurse-midwives and community health volunteers are key facilitators.

Implications of abortion legislation on birth defect surveillance

AbstractBackgroundSurveillance of birth defects is critical to track prevalence and inform prevention efforts. Previous studies suggest that restricting abortion may lead to an increase in birth defect prevalence. However, it is unclear how abortion legislation will impact birth defect prevalence estimates reported by state‐based surveillance programs.MethodsWe described current abortion legislation and surveillance program methodology, by state, as a foundation for understanding the program‐level impact on surveillance. We estimated the quantitative effect of abortion legislation on birth defect prevalence for various scenarios using first‐order Monte Carlo simulation. Finally, we discuss the implications for interpreting birth defect prevalence estimates following abortion legislation.ResultsAmong states that restrict abortion ≤18 weeks and have a surveillance program (N = 19), eight programs (42%) capture elective terminations (<20 weeks) and 17 (89%) include fetal deaths (≥20 weeks) in their estimates. Abortion bans increased the prevalence of any birth defect by 16.6%, 15.8%, and 8.7% for systems with live births only, all outcomes ≥20‐weeks, and all outcomes ≥10‐weeks, respectively. We found the largest change in prevalence for anencephaly with an estimated 32.5% increase among systems with live births only.ConclusionsAbortion legislation is likely to further exacerbate the difficulties of multi‐state birth defect research and surveillance, while also hindering analysis of intra‐state prevalence trends. Birth defect surveillance systems in states with abortion bans may wish to consider monitoring and reporting changes in pregnancy outcomes and infant survival, in addition to birth defect prevalence, to inform public health and health care service needs.

A Theological Review of the Practice of Abortion among Unmarried Women in India

In 2022, the Supreme Court of India has legalized abortion for all women, regardless of marital status. Consequently, all women in India are free to terminate their pregnancy without having to face a legal case. This decision is a breakthrough for new laws in India, including the issue of upholding women's rights. Even so, the act of arbitrary abortion is contrary to morals and Bible teachings. This article aims to discuss the legalization of abortion carried out by the Indian government from a biblical theology perspective by using a literature review approach. The findings of this research indicate that legalizing abortion through legislation is contrary to the biblical principle of the right to life. The government must guard abortion cases not only from political and socio-economic roles but also from religious beliefs and provide good sex education and a healthy environment for its people to suppress unwanted abortions. The role of parents in educating children and the role of the church in maturing the faith of the younger generation can prevent free sex and unsafe abortion in India. The contribution of this research is related to abortion, the right to life of the fetus, women's rights, sex education for the younger generation, parenting and government law.

Abortion Indications According to Law Number 17 of 2023 concerning Health

This normative juridical research scrutinizes Indonesia's legal framework surrounding abortion, juxtaposing the criminalization of abortion with the nuanced provisions of Law Number 17 of 2023 concerning health. The study focuses on Article 42, which permits abortion under specific indications such as fetal viability challenges and pregnancies resulting from rape. The primary legal materials are sourced from statutory regulations, with a supplementary examination of secondary legal materials. The research reveals the legal complexities surrounding abortion in Indonesia, shedding light on the delicate balance between criminal sanctions and legal protections. The implications of the findings extend to the broader discourse on reproductive rights and the evolving legal landscape.
 Highlights:
 
 
 Abortion Legislation in Indonesia: Balancing criminal sanctions and legal protections under Health Law Number 17 of 2023.
 
 
 Indications and Protections: Analyzing specific indications like fetal viability challenges and rape pregnancies, shaping women's reproductive rights.
 
 
 Normative Juridical Research: Utilizing primary and secondary legal materials to navigate the intricate legal landscape surrounding abortion in Indonesia.
 
 
 Keywords: Abortion, Planning, Legal Protection

189. Young People’s Knowledge and Understanding of Abortion Laws in a Non-Restrictive State Following the Dobbs Decision

189. Young People’s Knowledge and Understanding of Abortion Laws in a Non-Restrictive State Following the Dobbs Decision

Navigating the post-Dobbs landscape: ethical considerations from a perinatal perspective.

Restrictive abortion laws have impacts reaching far beyond the immediate sphere of reproductive health, with cascading effects on clinical and ethical aspects of neonatal care, as well as perinatal palliative care. These laws have the potential to alter how families and clinicians navigate prenatal and postnatal medical decisions after a complex fetal diagnosis is made. We present a hypothetical case to explore the nexus of abortion care and perinatal care of fetuses and infants with life-limiting conditions. We will highlight the potential impacts of limited abortion access on families anticipating the birth of these infants. We will also examine the legally and morally fraught gray zone of gestational viability where both abortion and resuscitation of live-born infants can potentially occur, per parental discretion. These scenarios are inexorably impacted by the rapidly changing legal landscape in the U.S., and highlight difficult ethical dilemmas which clinicians may increasingly need to navigate.

Navigating a maze: Midwives’ identity response to the enactment of an abortion law in Chile

BackgroundChilean midwives have been identified as essential for successfully implementing an abortion law, a practice which could potentially be understood as contradicting their central mission. Nevertheless, to date, there has been no investigation into how Chilean midwives have incorporated induced abortion care provision into their professional identity. ObjectiveTo elucidate how Chilean midwives understand and provide abortion care and how they have (re)defined their professional identity to include induced abortion care. This article reports the findings of the second part of this aim. MethodsThis study was underpinned by a constructivist grounded theory methodology informed by a reproductive justice and feminist perspective. Midwives from Chile who have cared for women undergoing abortion were invited to participate in the study. After purposive and theoretical sampling, fifteen midwives were recruited. FindingsMidwives’ identity is woman-centred, with high value placed on their role protecting life. These two aspects of midwives’ identity are in contradiction when providing abortion care. Midwives’ identity results from and informs midwives’ practice. Midwifery regulation influences both practice and identity. The model ‘Navigating a maze’ explains the interaction of these three elements. ConclusionMidwives’ identity response to the enactment of the Chilean abortion law is an example of how professional identity must navigate regulation and practice to make sense of its purpose. In light of this study's findings, the current tension experienced in midwives’ identity should be carefully attended to prevent adverse outcomes for midwives and the Chilean population.

Rape-Related Pregnancies in the 14 US States With Total Abortion Bans

This cross-sectional study estimates the incidence of rape-related pregnancies in US states with abortion bans.

Whose Responsibility Is It to Define Exceptions in Abortion Bans?

This Viewpoint evaluates Texas’ proposals to define the scope of the life exception for the state’s abortion ban and argues that these approaches do not allow physicians to follow the national standards of care, avoid criminal liability, or have sufficient notice of what the law permits.

A qualitative exploration of young female Muslims’ perspectives of abortion and belonging following the 2018 Irish Abortion Referendum

IntroductionIn 2018, Ireland conducted a referendum, ultimately supporting the legalisation of abortion. The views of religious minority groups can go unheard ‘by an insensitive majority’ in national cultural debates. This study explores female Muslim Irish university students’ perspectives on abortion and the impact of the 2018 Irish abortion debate on their sense of belonging within Ireland.MethodsTen female Muslim university students completed semi-structured interviews. The interview comprised seven open-ended questions examining perspectives on abortion and a sense of national belonging. A thematic analysis was carried out on the data.ResultsSix major themes emerged: (1) specific circumstances, (2) Islam, (3) family, (4) misuse of new laws, (5) stable sense of national belonging, (6) consequences of historical abortion legislation. Participants were largely supportive of the legal changes. Participants indicated that their sense of national belonging might have been affected if their religious beliefs had conflicted with the referendum outcome.ConclusionsParticipants largely supported the legalisation of abortion in Ireland, provided that the new laws aligned with their Islamic beliefs. The research indicated the referendum did not affect young Muslim women’s sense of belonging in Ireland.Policy ImplicationsMany national debates on social issues focus on winning majority support. This research highlighted the importance of canvasing and reflecting on the perspectives of people from minorities in order to reinforce a sense of larger political belonging.

US Obstetrician-Gynecologists' Perceived Impacts of Post–Dobbs v Jackson State Abortion Bans

Following the Dobbs v Jackson Women's Health Organization decision in June 2022, 17 US states have functionally banned abortion except in narrow circumstances, and physicians found in violation of these laws face felony charges, loss of their medical license, fines, and prison sentences. Patient impacts are being studied closely, but less research has focused on the consequences for obstetrician-gynecologists (OB-GYNs), for whom medically necessary care provision may now carry serious personal and professional consequences. To characterize perceptions of the impact of abortion restrictions on clinical practice, moral distress, mental health, and turnover intention among US OB-GYNs practicing in states with functional bans on abortion. This qualitative study included semistructured, remote interviews with OB-GYNs from 13 US states with abortion bans. Volunteer sample of 54 OB-GYNs practicing in states that had banned abortion as of March 2023. State abortion bans enacted between June 2022 and March 2023. OB-GYNs' perceptions of clinical and personal impacts of abortion bans. This study included 54 OB-GYNs (mean [SD] age, 42 [7] years; 44 [81%] female participants; 3 [6%] non-Hispanic Black or African American participants; 45 [83%] White participants) who practiced in general obstetrics and gynecology (39 [72%]), maternal-fetal medicine (7 [13%]), and complex family planning (8 [15%]). Two major domains were identified in which the laws affected OB-GYNs: (1) clinical impacts (eg, delays in care until patients became more sick or legal sign-off on a medical exception to the ban was obtained; restrictions on counseling patients on pregnancy options; inability to provide appropriate care oneself or make referrals for such care); and (2) personal impacts (eg, moral distress; fears and perceived consequences of law violation; intention to leave the state; symptoms of depression and anxiety). In this qualitative study of OB-GYNs practicing under abortion bans, participants reported deep and pervasive impacts of state laws, with implications for workforce sustainability, physician health, and patient outcomes. In the context of public policies that restrict physicians' clinical autonomy, organization-level supports for physicians are essential to maintain workforce sustainability, clinician health and well-being, and availability of timely and accessible health care throughout the US.

Seroprevalence and Risk Factors Associated with Chlamydia abortus Infection in Sheep and Goats in North-Western Italy.

Chlamydia abortus, although poorly recognized as a human pathogen, is a zoonotic microorganism that can cause many different symptoms in humans, including subclinical infection and fatal illnesses in pregnant women. C. abortus is one of the most common causes of ovine and caprine infectious abortion worldwide, known as the causative agent of the enzootic abortion of ewes (EAE) or ovine enzootic abortion (OEA). To estimate C. abortus seroprevalence and the risk factors related to C. abortus in small ruminants, the sera from 3045 animals (both sheep and goat) belonging to 202 herds were tested and a questionnaire investigating flock management was administered. At the herd level, the true seroprevalence was 56.6% (CI95%: 46.9-66.3%), at sheep-farm and goat-farm level, the true seroprevalence was 71.4% (CI95%: 54.6-88.3%) and 44.8% (CI95%: 41.3-57.0%), respectively. The true seroprevalence was significantly higher among the sheep than the goats. The logistic regression model identified four factors associated with Chlamydia seropositivity: flock size (i.e., farms with >50 heads), contact with cattle, introduction of animals, and Coxiella seropositivity. The study evidenced a high seroprevalence of Chlamydia abortus in small ruminant farms in the Piedmont region. Considering its zoonotic potential and the health consequences in humans, communication to farmers on the importance of vaccination, as well as the sensibilization of farm vets, seem to be strategical.

Abortion in The United States – The Impact of Changing Legislation on Prescription Patterns in Pediatric and Maternal Populations

Background and Hypothesis: Changes in healthcare legislation may have unintended consequences for patient care at the individual level. Following the Supreme Court case Dobbs vs Jackson Women’s Health Organization in 2022 resulting in the reversal of Roe V. Wade, many states enacted new abortion legislation. Currently, there are many restrictions and barriers to abortion and reproductive care that may limit access across the country. Given the volatile political environment surrounding abortion legislation, there may be some confusion among clinicians about the legality of abortion and miscarriage care. Abortion legislation and restriction may have an impact on other areas of healthcare, including prescription patterns of Category X medications in women of childbearing age. Based on the current legislation, we hypothesize that prescription rates of Category X medications will decrease while prescription rates of birth control methods will increase.
 Project Methods: Real world data on prescribing patterns will be obtained from IUH Cerner database and the Cerner Learning Health Network. Demographic information including age, race and insurance status will be obtained. Data will be analyzed to assess trends in prescription patterns for women of childbearing age that correlate with dates of changing abortion legislation.
 Potential Impact: The findings from this study will help direct future research on medication prescription and administration in people of childbearing age. Results may also inform future policy changes surrounding women’s healthcare.

The current panorama of the legislation on the legal interruption of pregnancy in Mexico

The interruption of pregnancy is a topic of great controversy in various areas. In Mexico, most criminal legislation defines abortion as the death of the product of conception at any time during pregnancy. With the evolution in the recognition and defense of human rights, it has currently been considered that the prohibition of abortion affects the exercise of reproductive freedom and access to health services, since it forces women to a procreation and are prevented from accessing safe abortion. Thus, approximately a third of local laws have modified the crime of abortion to define it as the interruption of pregnancy after the twelfth week of gestation; With this, a trend has begun towards not prohibiting this procedure during the first twelve weeks of pregnancy. However, it is not without ethical and legal implications, since health personnel may also object to participating for reasons of conscientious objection.

Backlash and Counter-Backlash: Safeguarding Access to Legal Abortion in Brazil

This article addresses the backlash against reproductive rights during Jair Bolsonaro’s government, focusing on access to legal abortions. Although access to abortion is quite restricted in Brazil, under Bolsonaro it was further curtailed through institutionalised spaces of power. This was met by counter-backlash actions, with an intensification of feminist activism in an attempt to secure an agenda of hard-won reproductive rights. To address this struggle for reproductive rights and against restrictions, we focus our analysis on the high-profile media case of an 11-year‑old girl, pregnant after being raped.

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.

‘We had that abortion together’: abortion networks and access to il/legal abortions in Turkey

Abortion was legalised in Turkey in 1983 with a 10-week limit, restrictions on who could provide abortions, and spousal or parental consent requirements. Currently, although abortion is legal, because of structural barriers, access is restricted (O’Neil, Altuntaş, and Keskin 2020). This study aimed to investigate how women strategically mobilise their social networks to overcome such restrictions to abortion care. Drawing from 25 in-depth interviews with urban-educated cis-women aged 24-30, I identify three groups within abortion networks: included, excluded and ambiguous. While included groups comprised largely of female family and friends, excluded groups were male family members and organisations, and the ambiguous category included health professionals and partners. Supporting findings in other contexts, individuals initially utilise their abortion networks to access the provider, they then build abortion solidarity networks to act as buffers against groups they wish to exclude during the abortion experience. Additionally, I show that excluded and ambiguous networks also impact abortion access, decision-making, and experience, even pushing individuals to follow through with illegal or semi-legal abortion procedures. Findings draw attention to the structural boundaries surrounding abortion laws, how patriarchal institutions make access to abortion care and abortion networks challenging, and how social networks may be utilised to alleviate such obstacles.

More Than Abortion: Why Reproductive Justice Matters in Cincinnati Post-Roe

ABSTRACT This study examines Reproductive Justice (RJ) for Black women in Cincinnati. While recognizing the importance of ensuring safe, legal, and affordable abortion access, RJ extends beyond this narrow focus and delves into the complex intersections of race, gender, sexuality, and social class. Employing principles from Black feminist praxis in utilizing Community-Based Participatory Research (CBPR) methods, we conducted qualitative interviews to center the voices and experiences of 24 self-identified Black women. The research uncovers three main themes: 1) Ideological violence against Black women, with subthemes: beauty and body image, strength and resilience, and stigmatized mothering; 2) Distrust in daycare services; and 3) Hurdles for low income women in accessing abortion care. These findings shed light on a post-Roe reproductive justice landscape for Black women in Cincinnati.

Dobbs, Gender Animus, and the Impact on Abortion Providers

ABSTRACT In this article we engage in a critical legal analysis of the Supreme Court’s decision in (Dobbs v. Jackson Women’s Health Organization). We argue that by refusing to connect opposition to abortion with “invidiously discriminatory animus against women” (2246), the Court successfully insulated itself from having to consider the devastating impact overturning Roe v. Wade (Roe) and Planned Parenthood v. Casey (Casey) would have on women’s lives with a disparate impact on structurally marginalized communities. Through an examination of the opinion of the dissenting Justices, we highlight the operationalization of gender animus as the “curtailment of women’s rights, and of their status as free and equal citizens” (2318). Against this legal backdrop, we draw upon 22 semi-structured interviews to examine gender animus through the lived experiences of clinicians practicing in both abortion prohibitive and abortion protective states. Participants discuss how gender animus has manifested through their sense of professional and legal precarity and the impact of abortion restrictions and bans on their patients.