Cost Of Abortion Research Articles

Barriers to accessing abortion care: an analysis from the perspective of unintended pregnant women-findings from the ELSA study

Barriers to accessing abortion care can delay access to services, which can lead to delayed abortion and health risks. Barriers include geographical accessibility, confidentiality, waiting times, stigmatization, poor or inaccessible information and the cost of abortion. This article examines barriers to accessing abortion care in Germany. This includes barriers in the availability and accessibility of care services, access to information, costs associated with abortion and organisational barriers. The analyses are based on data from an online cross-sectional survey of 594 women in Germany who had an unwanted pregnancy terminated, which was conducted as part of the ELSA Study in 2021 and 2022. The findings indicate that access to abortion care in Germany is associated with various barriers for many women. Of the respondents, 80.1% reported at least one barrier to accessing abortion, 65.5% reported more than two barriers and 40.5% reported three or more barriers. In particular, the non-disclosure of the procedure and the associated fear of stigmatisation represented hurdles for many participants. The results of the study underline the need to improve access to safe abortions. Reducing access barriers therefore includes the decriminalisation of abortion, acomprehensive care structure, financial support services, improved information services and the reduction of stigmatisation and discrimination.

Impact of bovine herpesvirus-1 infection on fertility in dairy cattle

Bovine herpesvirus-1 (BoHV-1) is endemic in the UK dairy herd and can have an important negative impact on fertility. As well as being the cause of infectious pustular vulvovaginitis and infectious balanoposthitis, BoHV-1 can reduce conception rate following introduction of the virus in contaminated semen at the time of artificial insemination. Its ability to cause abortions, particularly in the last trimester, is well-documented and the incidence of abortions can be high following the introduction of infection to naïve herds. The impact of BoHV-1 on herd fertility will depend on the degree of herd immunity, route of infection and strain of BoHV-1. Vaccination has been shown to reduce spread of BoHV-1 within and between herds, and to significantly reduce the risk of abortion. In light of the cost of a single abortion, and the impact of BoHV-1 on milk yield, routine vaccination against BoHV-1 offers a cost-effective control strategy suitable for most UK dairy herds.

Pricing of medication abortion in the United States, 2021-2023.

Financial costs remain one of the greatest barriers to abortion, leading to delays in care and preventing some from getting a desired abortion. Medication abortion is available through in-person facilities and telehealth services. However, whether telehealth offers a more affordable option has not been well-documented. We used Advancing New Standards in Reproductive Health (ANSIRH)'s Abortion Facility Database, which includes data on all publicly advertising abortion facilities and is updated annually. We describe facility out-of-pocket prices for medication abortion in 2021, 2022, and 2023, comparing in-person and telehealth provided by brick-and-mortar and virtual clinics, and by whether states allowed Medicaid coverage for abortion. The national median price for medication abortion remained consistent at $568 in 2021 and $563 in 2023. However, medications provided by virtual clinics were notably lower in price than in-person care and this difference widened over time. The median cost of a medication abortion offered in-person increased from $580 in 2021 to $600 by 2023, while the median price of a medication abortion offered by virtual clinics decreased from $239 in 2021 to $150 in 2023. Among virtual clinics, few (7%) accepted Medicaid. Median prices in states that accept Medicaid were generally higher than in states that did not. Medication abortion is offered at substantially lower prices by virtual clinics. However, not being able to use Medicaid or other insurance may make telehealth cost-prohibitive for some people, even if prices are lower. Additionally, many states do not allow telehealth for abortion, deepening inequities in healthcare.

A New Tool to Assess the Economic Impact of Q Fever on Dairy Cattle Farms.

To support farmers in their decisions related to Q fever, a dedicated economic assessment tool is developed. The present work describes the calculator, its economic rationale, and the supporting assumptions. The calculator integrates a yearly compartmental model to represent population dynamism and the main interactions between disorders linked to Q fever, especially reproductive disorders (abortion, retained foetal membranes, purulent vaginal discharge and endometritis, extra services, and calving-conception delays). The effects of the nontangible cost of the disease on human health, the welfare of the animals, and the workload of farmers were not integrated into the model. The model shows high-level sensitivity to the prevalence of Q fever in the herd prevaccination and to the costs of abortion and extra days of calving-conception intervals. Breakeven points, i.e., cost values that allow us to achieve positive vaccination benefits, are also reported. For herds with moderate or high prevalence rates of Q fever prevaccination (>30%), a vaccination benefit is observed. The vaccine should be considered a type of insurance in herds with low prevalence rates of Q fever prevaccination (≤20%). The calculator was developed to aid decision-making at the farm level, and no conclusion can be extrapolated as a generic trend based on the present work.

Client-reported quality of facility-managed medication abortion compared with pharmacy-sourced self-managed abortion in Bangladesh

ObjectiveWe used the newly developed Abortion Care Quality Tool (ACQTool) to compare client-reported quality of medication abortion care by source (facility-managed vs pharmacy-sourced self-managed abortion (SMA)) in Bangladesh.MethodsWe leveraged exit...

A systematic review of economic assessments for brucellosis control interventions in livestock populations.

Brucellosis in livestock is a disease of paramount importance to animal and human health authorities due to its socio-economic and public health consequences. Benefit cost analyses can help policymakers decide whether allocation of resources is economically beneficial to cover the costs of brucellosis control interventions in populations. One broad question of interest is: what are the consequences of acting, or failing to act, on policy options of selected intervention scenarios (e.g., vaccination, test-and-slaughter, vaccination combined with test-and-slaughter, versus a status-quo scenario). The objective of the systematic review reported here was to conduct a critical appraisal of published research reports of economic assessments of brucellosis control interventions in livestock populations. The systematic review followed standard guidelines using a Population, Intervention, Comparison, Outcome, and Context framework and Preferred Reporting Items for Systematic Review and Meta-Analysis. The review targeted research reports focused on brucellosis control interventions in livestock populations at the national or regional level. Economic outcomes of interest were benefit-cost ratio (BCR), net present value, internal rate of return, or payback period. Eleven studies conducted in Brazil, China, India, Iraq, Mexico, Mongolia, Spain, Turkey, or the USA met the inclusion criteria and were included. The baseline prevalence of brucellosis in selected study populations ranged from 1.4% in cattle in Turkey to 20% in goats in Mexico. In six studies, selected intervention scenarios of vaccination alone produced BCRs that ranged from 3.2 in yaks in China or in cattle, sheep and goats in Mongolia, to 21.3 in cattle and/or buffalo in India. In three studies, interventions of test-and-slaughter produced BCRs that ranged from -1.2 in goats in Mexico to 0.6 in cattle in Spain. In four studies, vaccination in combination with test-and-slaughter produced BCRs that ranged from 0.2 in yaks in China to 3.7 in cattle and buffalo in India. In seven studies, using sensitivity analysis, different input parameters (prevalence of brucellosis, meat price, cashmere price, vaccination coverage, test-and-slaughter coverage, milk price, vaccination protection, abortion cost, abortion rate, or price of lamb) had an impact on economic outcomes. Vaccination alone was cost-effective, but test-and-slaughter was not, for brucellosis control in selected livestock populations in focus countries. Vaccination in combination with test-and-slaughter produced profitable or nonprofitable economic outcomes. While most studies reported the cost and benefits of implementing brucellosis control interventions, only one study explained socio-economic consequences of economic outcomes, when acting, or failing to act, on selected interventions in livestock populations.

Assessing Factors Contributing to Unsafe Abortion Practice among Women of Reproductive Age

The aim of the study was to investigate the factors contributing to unsafe abortion practices among women of reproductive age. Being a case study, this study used a mixed methodology approach which embraces the best of both qualitative and quantitative approaches, as this approach provides the researcher with both “breadth and depth in” obtaining a holistic understanding of social phenomena. The target population of this study comprised adolescent girls, that is, girls and women aged between 18 years and 25 years who are either in school or have dropped out after falling pregnant. This study used both qualitative and quantitative methods and relied on both quantitative and qualitative techniques of data analysis. The results indicate that reforming laws that regulate a highly stigmatized action takes time and may follow years of using multidisciplinary strategies to highlight the public health consequences and costs of unsafe abortion. Zambia is similar to other countries in the region with restrictive abortion laws in that many countries spell out the grounds for when abortion is not punishable in national penal codes. The recommendations are that the government should lift the most egregious barriers to legal services, such as requirements that multiple physicians authorize abortions and that only physicians can provide them. All healthcare professionals who provide abortion must be trained in WHO-recommended techniques, and the use of dilation and curettage must be discontinued. This invasive method should be completely replaced by either medication abortion or vacuum aspiration. Keywords: Abortion, Government, Health, Medical, NGOs.

Assessing psychosocial costs: Ohio patients’ experiences seeking abortion care

ObjectivesExisting research has not thoroughly characterized the psychosocial costs associated with seeking abortion care in restrictive states. Our study seeks to fill this gap by analyzing the accounts of Ohio abortion patients from 2018 to 2019. Study designUsing inductive and deductive approaches, we analyzed semi-structured in-depth qualitative interviews with 41 Ohio residents who obtained abortion care from one of three clinics in Ohio or Pennsylvania. ResultsOhioans seeking abortion care often experienced fear of judgment, interpersonal strain, and stress as a result of efforts to overcome pre-Dobbs financial, geographic, and timing challenges. Those who needed financial assistance or traveled more than an hour generally reported greater exposure to psychosocial costs. ConclusionsParticipants in this study incurred a complex set of psychosocial costs. Psychosocial costs often resulted from, or were exacerbated by, the financial, geographic, and time-sensitive burdens that patients experienced seeking care. ImplicationsThe psychosocial costs incurred by patients seeking abortion care may be exacerbated in restrictive contexts, especially those who do not have access to insurance coverage for care. Psychosocial costs associated with care seeking are likely to increase as states implement more severe restrictions post-Dobbs. To fully understand abortion costs, researchers must examine costs comprehensively, including both financial and psychosocial costs.

Trends In Self-Pay Charges And Insurance Acceptance For Abortion In The United States, 2017-20.

The Hyde Amendment prevents federal funds, including Medicaid, from covering abortion care, and many states have legal restrictions that prevent private insurance plans from covering abortion. As a result, most people pay for abortion out of pocket. We examined patient self-pay charges for three abortion types (medication abortion, first-trimester procedural abortion, and second-trimester abortion), as well as facilities' acceptance of health insurance, during the period 2017-20. We found that during this time, median patient charges increased for medication abortion (from $495 to $560) and first-trimester procedural abortion (from $475 to $575) but not second-trimester abortion (from $935 to $895). The proportion of facilities that accept insurance decreased over time (from 89percent to 80percent). We noted substantial regional variation, with the South having lower costs and lower insurance acceptance. Charges for first-trimester procedural abortions are increasing, and acceptance of health insurance is declining. According to the Federal Reserve, one-quarter of Americans could not pay for a $400 emergency expense solely with the money in their bank accounts-an amount lower than any abortion cost in 2020. Lifting Hyde restrictions and requiring public and private health insurance to cover this essential, time-sensitive health service without copays or deductibles would greatly reduce the financial burden of abortion.

Financial Hardships Caused by Out-of-Pocket Abortion Costs in Texas, 2018.

Objectives. To identify financial hardships related to costs of obtaining abortion care in Texas, which has the highest uninsured rate in the United States and restricts insurance coverage for abortions. Methods. We surveyed patients seeking abortion at 12 Texas clinics in 2018 regarding costs and financial hardships related to abortion care. We compared mean out-of-pocket costs and the percentage reporting hardships across income and insurance categories. Results. Of 603 respondents, 42% were Latinx, 25% White, and 21% Black or African American, and most (62.0%) reported having low incomes (< 200% federal poverty level). Mean out-of-pocket costs were $634, which varied little across insurance groups. Patients with low incomes were more likely to obtain financial assistance from an abortion fund than were wealthier patients (12.3% vs 1.6%, respectively; P < .05). Financial hardships related to abortion costs were more common among uninsured (57.6%) and publicly insured (55.1%) patients than those with private insurance (48.2%). One in 5 (19.8%) uninsured respondents delayed buying food to pay for abortion care. Conclusions. Restrictions on insurance coverage for abortions result in high out-of-pocket costs and major financial hardships for most patients with low incomes in Texas. (Am J Public Health. 2022;112(5):758-761. https://doi.org/10.2105/AJPH.2021.306701).

Cost Analysis of Surgical and Medical Uterine Evacuation Methods for First-Trimester Abortion Used in Public Hospitals in Mexico.

Background:Data on abortion procedures costs are scarce in low- and middle-income countries. In Mexico, the only known study was conducted more than a decade ago, with data from years before the abortion legislation. This study estimated the costs, from the health system’s perspective, of surgical and medical abortion methods commonly used by women who undergo first-trimester abortion in Mexico.Methods:Data were collected on staff time, salaries, medications, consumables, equipment, imaging, and lab studies, at 5 public general hospitals. A bottom-up micro-costing approach was used.Results:Surgical abortion costs were US$201 for manual vacuum aspiration and US$298 for sharp curettage. The cost of medical abortion with misoprostol was US$85. The use of cervical ripening increases the costs by up to 18%. Staff comprised up to 72% of total costs in surgical abortions. Hospitalization was the area where most of the spending occurred, due to the staff and post-surgical surveillance required.Conclusions:Our estimates reflect the costs of “real-life” implementation and highlight the impact on costs of the overuse of resources not routinely recommended by clinical guidelines, such as cervical ripening for surgical abortion. This information will help decision-makers to generate policies that contribute to more efficient use of resources.

Economic cost of pregnancy care attributable to the failure of Mexico's teenage pregnancy prevention policy

The objective was to estimate the direct medical cost of pregnancy care attributable to the failure of Mexico's teenage pregnancy prevention policy. From the provider's perspective, this economic study estimated the mean cost of prenatal care, childbirth, puerperium, abortion and complications. To quantify the costs attributable to policy failure, three scenarios were constructed: (a) total number of pregnancies; (b) number of pregnancies above the target; (c) number of unwanted pregnancies. The cost of providing contraceptive methods was also estimated and the characteristics of pregnant adolescents were described. Of the adolescents (n = 5,477,027), 30.2% were sexually active; 46.8% used contraception; 44.1% had become pregnant and 9.1% had an abortion. Most pregnant women (65%) attended secondary school or under; 30% dropped out of school; 72.5% lived with a partner; 72.3% had complications. The mean cost of pregnancy care was estimated at USD 2,210.55 and the mean cost of providing contraceptives at USD 64.95. The total cost of policy failure was estimated for each scenario (in millions): (a) USD 1,614.39, (b) USD 876.61 and (c) USD 171.50, respectively; whereas the annual cost of providing contraceptives in each scenario was estimated in: (a) USD 47.43, (b) USD 25.76 and (c) USD 5.04. The failure of the policy is expressed in the high frequency of pregnancy in low-income adolescents and in high costs for the health system. The provision of contraceptives is 34 times cheaper than pregnancy care and could, together with improved living conditions, contribute to reduce the frequency of adolescent pregnancies.

Barriers to medication abortion among Massachusetts public university students

ObjectiveProposed legislation in Massachusetts would require public university health centers to provide medication abortion services on campus. This study assesses need for these services by investigating current travel time, costs, wait times and insurance acceptance at off-campus, abortion-providing facilities nearest to public universities in Massachusetts. Study DesignThis investigation projected the total number of students obtaining medication abortions each year at the 13 Massachusetts public universities based on campus enrollment figures and age- and state-adjusted medication abortion rates. Using a cross-sectional study design, the research calculated the distance and public transit time from campuses to the nearest abortion-providing facilities. Researchers contacted facilities to determine costs, wait times and insurance acceptance. ResultsWe estimate 50 to 115 of Massachusetts public university students obtain medication abortion services each month, or 600 to 1,380 each year. Students have to travel between 2 and 42 miles to reach the nearest abortion-providing facility, with a population-weighted average distance of 19 miles each way. Travel time on public transportation to reach the nearest abortion-providing facility takes between 18 and 400 hundred minutes, with a population-weighted average of 103 minutes each way. Average cost of medication abortion was $680, and average wait time to the first available appointment was 8 days. Eight of 13 abortion-providing facilities did not have weekend appointments. All of the nearest abortion-providing facilities in Massachusetts accepted Mass Health, but one nearest facility was out of state and did not. All accepted multiple private insurance plans. ConclusionsCollege students face cost, scheduling, and travel barriers to abortion care. Offering medication abortion on campus would reduce these barriers. ImplicationsThe barriers to medication abortion experienced by students attending public universities in Massachusetts fall particularly hard on female and low-income students, who are disproportionately students of color. Offering medication abortion on campus would reduce these barriers and enhance gender and racial equity on campus.

The economic context of pursuing online medication abortion in the United States

Access to in-clinic abortion has become increasingly restricted in the U.S. and for many, the high cost of care is a significant barrier. However, little is known about how financial circumstances shape the alternate pathways to abortion care people seek when the clinic is out of reach. In a unique sample of people who used medication abortion pills from Aid Access, a non-profit telemedicine service, we examine the impact of economic circumstances on abortion care pathway decision-making and experiences seeking care. Between June and August 2019, we conducted 80 anonymous, semi-structured in-depth interviews with U.S. residents who self-managed their own abortions using medication abortion pills from Aid Access. Participants were asked about their experiences seeking abortion, and their motivations for using the service. We coded interviews using an iteratively developed coding guide and performed thematic analyses to identify key themes. The unaffordable cost of in-clinic abortion was a key reason why participants sought care using online telemedicine. Experiences of personal financial hardship exacerbated by restrictive policies impacted participants’ ability to access the clinic. For participants with children, their financial decisions were further guided by the concerns of providing economic stability for their family. Although telemedicine was considered more affordable than in-clinic care, for some, the suggested donation of $90 still posed a financial burden and accessing pills at no cost or a reduced cost was necessary. The availability of affordable telemedicine and policy interventions addressing Medicaid and insurance coverage for abortion would democratize abortion access for populations with low incomes.

Economic impacts of Bovine alphaherpesvirus 1 infection in Brazil: Meta-analysis based on epidemiological indicators

This study aimed to conduct a systematic review to estimate the economic impact of Bovine alphaherpesvirus 1 (BoAHV1) infection in Brazil using epidemiological indicators through a meta-analysis. Specific descriptors were used to retrieve studies from the Scopus, PubMed, Biblioteca Digital Brasileira de Teses e Dissertações, and Catálogo de Teses e Dissertações da Capes databases, selecting those that met the inclusion criteria established between the years 2000 and 2020. The selected studies were subjected to descriptive statistical analysis using prevalence data as the primary outcome with a 95% confidence interval (CI) with a meta-analysis of random effects and measures of heterogeneity, significance, magnitude of the effect, and measurement of publication bias. Abortion costs and estimates were calculated based on the prevalence of BoAHV1 infection in Brazil and the characteristics of the agent as viral subtypes that cause abortion, period of occurrence, average pregnancy rate, and morbidity applied to susceptible animals and animal replacement values. The results were obtained from 49 studies included for meta-analysis where a prevalence of BoAHV1 infection of 54.12% (95% CI: 49.07% - 59.26%) in the bovine population and 88.53% (95% CI: 82.97%–92.43%) was present. From the structured formula, it is estimated that 258,779 bovine abortions occur, which causes a total loss, based only on the occurrence of abortion, of US $ 48,402,244.00 to the country. It is noteworthy that because of the losses caused, strict control and eradication measures need to be implemented based on the elaboration of normative instruction that includes health education measures, vaccination, tests for traffic, and animal trade so that BoAHV1 infections do not continue to negatively impact national producers economically, productively, and socially.

The macroeconomics of abortion:A scoping review and analysis of the costs and outcomes.

Although abortion is a common gynecological procedure around the globe, we lack synthesis of the known macroeconomic costs and outcomes of abortion care and abortion policies. This scoping review synthesizes the literature on the impact of abortion-related care and abortion policies on economic outcomes at the macroeconomic level (that is, for societies and nation states). Searches were conducted in eight electronic databases. We conducted the searches and application of inclusion/exclusion criteria using the PRISMA extension for Scoping Reviews. For inclusion, studies must have examined one of the following macroeconomic outcomes: costs, impacts, benefits, and/or value of abortion care or abortion policies. Quantitative and qualitative data were extracted for descriptive statistics and thematic analysis. Of the 189 data extractions with macroeconomic evidence, costs at the national level are the most frequently reported economic outcome (n = 97), followed by impacts (n = 66), and benefits/value (n = 26). Findings show that post-abortion care services can constitute a substantial portion of national expenditures on health. Public sector coverage of abortion costs is sparse, and individuals bear most of the costs. Evidence also indicates that liberalizing abortion laws can have positive spillover effects for women's educational attainment and labor supply, and that access to abortion services contributes to improvements in children's human capital. However, the political economy around abortion legislation remains complicated and controversial. Given the highly charged political nature of abortion around the global and the preponderance of rhetoric that can cloud reality in policy dialogues, it is imperative that social science researchers build the evidence base on the macroeconomic outcomes of abortion services and regulations.

SOCIAL SCIENCE ORAL ABSTRACTS: Trends in self-pay costs and insurance acceptance for abortion across the United States, 2017 to 2020

<h3>Introduction</h3> Abortion cost can be a significant financial burden and a barrier to care. The Hyde Amendment prevents Federal funding from being used for abortion care, forcing many low-income people to pay for abortion out of pocket rather than using their Medicaid coverage. Current data on self-pay abortion costs are limited to national estimates or small sample sizes. We provide data on trends in self-pay abortion costs by region for medication abortion and first and second trimester procedures using a national database of abortion clinics in the United States. We also examine the proportion of clinics that accept any type of insurance. <h3>Method</h3> We used data from University of California San Francisco (UCSF)/Advancing New Standards in Reproductive Health (ANSIRH's) abortion facility database which includes data on publicly advertising abortion clinics and is updated each year. We used Chrome browser's incognito mode to search for clinics by State and City using the key words: "Abortion clinic in [State]", "Abortion clinic in [City]" for all cities with a population of 100,000 or larger in each state, and the 3 largest cities for states that did not have a city of that size. We examined links to clinics from the first 3 pages of results for states and first 2 pages for cities. We then conducted mystery shopper phone calls to clinics to supplement any missing data not found on facility web pages. Mystery callers did not make clinic appointments. Clinics were only included if they reported being open and providing abortions for a given year. Abortion training sites such as teaching hospitals were only included if they publicly advertised abortion services. To estimate mean costs of abortion for clinics that gave a range of prices for a certain abortion type (e.g., second trimester) we first averaged the prices for that procedure type per clinic. Then, clinic mean prices were averaged by region to develop regional means. We reported the number and percentage of clinics in each region that reported accepting any insurance. <h3>Results</h3> We identified 751 to 776 publicly advertising abortion clinics per year in the United States: 776 in 2017, 751 in 2018, 758 in 2019, and 765 in 2020. The national mean self-pay price for medication abortion increased from $511 in 2017 to $644 in 2020. Mean price for medication abortion varied greatly by region, the lowest cost in 2020 being $489 in the South Atlantic and the highest being $873 in the Pacific. Nationally, mean first-trimester aspiration abortion costs also increased over time, from $489 to $715 between 2017 and 2020. Mean price for first-trimester aspiration abortion varied greatly by region, with the lowest cost in 2020 being $493 in the South Atlantic and the highest cost being $1191 in New England. In contrast, mean second trimester abortion costs decreased nationally, from $1180 in 2017 to $1068 in 2020. This decrease was mostly concentrated in the Pacific, East North Central, and New England regions, while other regions saw an increase in the same period. There was a sharp national decline in the proportion of clinics that accepted insurance from 88% to 80% between 2018 and 2019, which was sustained in 2020. This decline was observed in all regions. <h3>Conclusions</h3> An improved understanding of patient costs for an abortion and how that varies by region and state is a crucial first step to reducing financial barriers and to inform public and private insurance coverage policy. Abortion costs are increasing over time, while the proportion of clinics that accept insurance is decreasing. This may be because public and private insurance reimbursement rates do not cover the full costs of providing abortion care. Insurance reimbursement rates must be increased to reflect actual clinic costs. Additionally, repealing the Hyde Amendment would have profound impacts on people who have abortions in the United States.

Abortion Costs and Single Parenthood: A Life-Cycle Model of Fertility and Partnership Behavior

I estimate a structural model that nests four channels through which abortion costs impact partnership and fertility. Variation in parental consent laws helps to identify the relative importance of each theoretical channel, and simulations decompose total policy effects into theoretical channels. Results indicate that the largest effect of parental consent laws is on the abortion decision for pregnant minors. But there are also meaningful effects on marriage opportunities for pregnant minors and on sexual and contraceptive behavior. These effects combine to impact family structure and human capital accumulation over the life-cycle. Simulations show that parental consent laws reduce the accumulation of human capital via impacts of children on school attendance and also increase the probability that women spend time as unwed mothers. A counterfactual abortion ban is predicted to increase birth rates at all ages and subsequently increase unwed motherhood and reduce schooling.

A consequentialist ethical analysis of federal funding of elective abortions.

Insurance coverage of abortion varies widely across the United States and is an extensively debated issue. Medicaid coverage of abortion is particularly relevant because the majority of abortion patients are poor or low-income and are thus often covered by Medicaid. Since the Hyde Amendment was first passed in 1976, federal Medicaid funds have been banned from covering the costs of elective abortion. Although states are allowed to use their own funds to cover abortions for their Medicaid recipients, only 17 states currently do so. Of these 17 states, only five cover abortion costs voluntarily; the others do so pursuant to court order. The medical literature includes few ethical analyses of the Hyde Amendment's ban on Medicaid funding of elective abortions. To fill this gap, we perform an ethical analysis of federal policy to fund elective abortions using a consequentialist approach focused on consequences for pregnant women and their children.

Pregnancy Prevalence and Outcomes in 3 United States Juvenile Residential Systems.

To describe the number of admissions of pregnant adolescents to US juvenile residential systems (JRS) and the outcomes of pregnancies that ended while in custody. Prospective study. Three nonrandomly selected JRS in 3 US states. Designated reporter at each JRS reporting aggregate data on various pregnant admissions, outcomes, and systems' policies. None. Monthly number of pregnant people admitted, pregnant people at the end of the month, births, preterm births, cesarean deliveries, miscarriages, induced abortions, ectopic pregnancies, maternal and newborn deaths, and administrative policies. There were 71 admissions of pregnant adolescents reported over 12 months from participating JRS. At the time of the census, 6 of the 183 female adolescents (3.3%) were pregnant. Eight pregnancies ended while in custody. Of these, 1 pregnancy was a live full-term birth, 4 were miscarriages, and 3 were induced abortions. There were no newborn deaths or maternal deaths. Administrative policies and services varied among the JRS. For example, all JRS had a prenatal care provider on-site, whereas 2 JRS helped cover the costs of abortions. To our knowledge, this study is the first to report the estimates of pregnancy and pregnancy outcomes among justice-involved youth in JRS. Our findings indicate that there are pregnant adolescents in JRS and most return to their communities while pregnant, highlighting the importance of continuity of care. More work is needed to understand the complexities of health care needs of justice-involved pregnant youth during and after their incarceration.