Abortion Funding Research Articles

Exploring Consumer Preferences for Pharmacy Provision of Mifepristone in the Human-centered Design Discovery Phase

ObjectiveWe used human-centered design to explore preferred consumer experiences for obtaining mifepristone for medication abortion care from a pharmacy. MethodsWe conducted a two-part virtual workshop series with the same 10 participants in March and April of 2022 to initiate the discovery phase of a human-centered design process. Most participants were residents of Illinois and all participants had uteruses and had either sought abortion care or supported someone who had. Co-developed and co-facilitated with a local abortion fund, workshops engaged participants to provide formative data for the development of recommendations for community health center clinicians and pharmacists. A simulated medication abortion care counseling session grounded group activities and discussions that explored the experience of filling a medication abortion prescription at a pharmacy or by mail. Data were analyzed for key themes and recommendations. Qualitative data were collected from the workshops. Data analysis was conducted in three iterative, parallel stages: 1) virtual whiteboard results from both workshops were analyzed deductively through spreadsheets and visualizations; 2) close reading was conducted for workshop transcripts and participant evaluations; and 3) document analysis was used to triangulate data across formats. Data were discussed periodically among the research team until consensus was reached. ResultsFive primary categories of questions and preferences emerged from workshop data concerning: logistics, privacy, cost, pharmacist refusal, and follow-up care. Researchers found that participants desired certain questions and concerns to be answered by specific provider types. Participants indicated a desire for further research and opportunities that prioritize lived experience and use storytelling and/or design methods to collect data. ConclusionsDespite existing patient-oriented medication abortion resources, there is a need for patient resources to support pharmacy dispensing, and a corresponding need for clinician and pharmacist resources. These can help in-person and mail-order pharmacy dispensing TO be as consumer friendly as possible.

Patient navigation in reproductive healthcare.

This review summarizes evidence about barriers to abortion care pre-Dobbs and post-Dobbs, inequities in abortion access, and approaches to improving access to abortion care with use of patient navigators. The Dobbs decision and resulting state-level restrictions exacerbated economic, knowledge, and logistic barriers to abortion care. Abortion funds and emotional support are two main resources to help address these barriers; however, only with coordination can patients and clinics fully benefit from the resources. Patient navigation provides that coordination. Evidence shows it improves reproductive outcomes, is acceptable to patients and providers, and engages community health workers and community-based organizations. Increasing legal restrictions and barriers to abortion care have motivated advocates to identify effective interventions to facilitate patient-centered and culturally competent care. Navigators have improved postpartum care by increasing attendance, education and helping coordinate overall care. They have improved referrals and access to abortion care in statewide programs.

Decision and economic evaluation of abortion availability in the United States military

BackgroundActive-duty service women rely on the civilian sector for most abortion care due to limits on federal funding for abortion. Abortion is now banned in many states with large military presences. The Department of Defense has implemented policies to assist active-duty service women in accessing abortion, but there is debate to reverse this support. ObjectiveOur goal was to compare the cost-effectiveness and incidence of adverse maternal and neonatal outcomes of a hypothetical cohort of active-duty service women living in abortion-restricted states comparing restricted abortion access (abortion not available cohort) to abortion available with Department of Defense travel support (abortion available cohort). Study DesignWe developed a decision tree model to compare abortion not available and abortion available cohorts for active-duty service women living in abortion-restricted states. Our cohorts were subdivided into normal pregnancies and those with a major fetal anomaly. Cost estimates, probabilities, and disability weights of various health conditions associated with abortion and pregnancy were obtained and derived from the literature. Effectiveness was expressed in disability-adjusted life years and the willingness to pay threshold was set to $100,000 per disability-adjusted life year gained or averted. We completed probabilistic sensitivity analyses with 10,000 simulations to test the robustness of our results. Secondary outcomes included numbers of stillbirths, neonatal deaths, neonatal intensive care unit admissions, maternal deaths, severe maternal morbidities, and first and second trimester abortions. ResultsThe abortion not available cohort had a higher annual cost to the military ($299.1 million, 95% CI 239.2 – 386.6, vs. $226.0 million, 95% CI 181.9 – 288.5) and was associated with 203 more disability-adjusted life years compared to the abortion available cohort. The incremental cost effectiveness ratio was dominant for abortion available. Abortion not available resulted in an annual additional 7 stillbirths, 1 neonatal death, 112 neonatal intensive care unit admissions, 0.016 maternal deaths, 24 severe maternal morbidities, 27 less second trimester abortions, and 602 less first trimester abortions. Probabilistic sensitivity analysis revealed that the chance of the abortion available cohort being the more cost-effective strategy was greater than 95%. ConclusionLimiting active-duty service women’s access to abortion care increases costs to the military, even with costs of travel support, and increases adverse maternal and neonatal outcomes. This analysis provides important information for policymakers about economic and health burdens associated with barriers to abortion care in the military.

Seeking financial and practical support in an abortion-hostile state: Analysis of abortion fund data in Kentucky, 2014-2021: Analysis of abortion fund data in Kentucky.

Philanthropic abortion funds are integral to accessing care in the United States, providing both financial and practical assistance. Yet relatively little is known about those who seek these essential services. In this study, we analyzed data from a Kentucky abortion fund to assess characteristics of abortion fund callers. We analyzed 2014-2021 administrative data from the Kentucky Health Justice Network's (KHJN) Abortion Support Fund and compared them to abortion data from the Kentucky Department for Public Health (KDPH). We analyzed age, race, and pregnancy gestation at calling (KHJN) and abortion (KDPH), and calculated Z-scores and p-values to compare proportions in each category between the two data sources. The fund supported 6162 people from 2014 to 2021, when 28,741 people had abortions in Kentucky. Compared with KDPH data, KHJN had a higher percentage of callers who were under age 30, a higher percentage of callers who were Black or another race, and a higher percentage of callers at 14 weeks' gestation or higher. Compared with state data, KHJN supported a higher percentage of young people, people of color, and people at later gestations. These findings support evidence that structurally vulnerable groups are more likely to face barriers to care and that abortion funds provide essential support necessary for reproductive equity.

Immaterial intimacy: The neoliberal entanglement of digital technologies in social movement volunteer work

Outside of visible moments of mass mobilization, ongoing latent work, such as direct service and mutual aid, is a long-standing tradition in social movements. Yet, like all labor, personal digital devices have changed the norms and practices of direct service social movement work. In this article, as situated in the technology–media–movement complex (TMMC), I analyze qualitative interview data ( N = 26) with volunteers from a yearlong ethnographic project at an abortion fund hotline in the reproductive justice movement in the US South. To name hotline volunteers’ digital care labor, I offer the term immaterial intimacy to describe its ubiquitous, ephemeral, and intimate nature. I argue immaterial intimate labor enabled the organization to provide a responsive service, but relied on individualized digital volunteer work, existing within gendered and neoliberal norms. I discuss and question the use of personal digital technologies for direct service volunteer work in contemporary social movements.

"I Need Help With the Abortion, so I Won't Have to Ever See or Hear From Him Again": Relationship Barriers Faced by Abortion Fund Applicants in the Rocky Mountain West.

To explore the factors impacting abortion access for abortion fund clients, data from 816 applicants was analyzed using a summative content analysis approach. Nine relationship themes emerged for applicants who cited their partner as a significant factor in their abortion decision-making, including (a) power and control, (b) fear and safety concerns, (c) leaving the relationship, (d) barriers to accessing care, (e) sexual violence, (f) perpetration and victimization, (g) having an unsupportive partner, (h) being partnerless, and (i) having a supportive partner. Abortion funds are a potential resource for those experiencing intimate partner violence and can support survivors through confidential care and referrals.

The Association of Federal Medicaid Abortion Funding Restrictions With Adverse Obstetric Outcomes Among United States Medicaid Recipients

(Abstracted from Contraception 2023;126:110116) Obstetric care in the United States is predominantly paid for by Medicaid, which covers nearly half of all births. An essential component of comprehensive obstetric care is legal, safe abortion, and restricted access to such procedures is related to increased maternal mortality and morbidity.

Everyday Practices, Unaffordable Rights, Radical Liberation: Reproductive Justice Direct Service Activism

In post- Roe America, access to reproductive care is rapidly dwindling, with the criminalization of abortion on the rise. Yet, in these frustrating and perilous times, organizations, activists, and volunteers facilitate access to care every day via digital direct service activism. This article is a meditation on the transformational nature of direct service praxis in the contemporary reproductive justice movement. To document my own ongoing transformation, I include autoethnographic reflections on my experiences as a direct service volunteer from August 2021 to December 2022. Practices such as distributing abortion funding and peer counseling on an anonymous talkline have transformed my understanding and experience of liberation work. I want to draw attention to these quiet actions and exchanges that often go unnoticed in our loud, neoliberal capitalist context. These communions of care and connection help forge the future now, in small, radical, and tangible ways.

Exploring Contraceptive Experiences of Abortion-Fund Clients in the Rocky Mountain Region of the United States from a Reproductive Justice Lens

This study focuses on the contraceptive experiences of abortion-fund applicants to draw attention to various elements that restrict the realization of reproductive justice in the Rocky Mountain Region of the United States. This study uses qualitative data from 830 applications to an abortion fund submitted between 2013 and 2022. Our findings highlight a range of experiences, from contraceptive failure and side effects, to diminished access and reproductive coercion. Abortion-fund applicants described individual, interpersonal, and structural factors that shaped their access to contraception. This study calls for various interventions, including implementing comprehensive sex education, to ensure reproductive justice.

Recruiting pregnant people considering abortion: An analysis of differences in participant characteristics by recruitment site across online, abortion fund, and clinic-based sources

ObjectivesThis study aimed to evaluate differences by recruitment method in the characteristics of participants who are considering abortion. Study designBetween June 2021 and April 2022, we recruited pregnant people considering abortion in Indiana from (1) online posts, (2) abortion funds, and (3) abortion clinics. We compared participant characteristics reported in an online survey by recruitment source. ResultsCompared to those recruited from clinics (n = 94), participants recruited online (n = 84) and through abortion funds (n = 239) were later in their pregnancy, were already parenting, received less formal education, struggled financially, and were more likely to be Black or African American, queer, transgender, or nonbinary. ConclusionsRecruitment from online sources and abortion funds reaches more people who face greater barriers to abortion care than recruitment from clinics. ImplicationsAugmenting clinic-based recruitment with online and abortion fund recruitment could capture a more complete sample of people considering abortion.

The association of federal Medicaid abortion funding restrictions with adverse obstetric outcomes among United States Medicaid recipients

ObjectiveWe examine the association of the Hyde Amendment with obstetrical outcomes in a national Medicaid population. Study designWe conducted a national study of Medicaid-funded abortions to determine the association of restrictions on adolescent, preterm, low-birth weight, and short interpregnancy interval births using administrative data. ResultsStates that restricted coverage for abortion had a higher median rate of adolescent (10.2%; vs 7.4%; p-value < 0.001), preterm (11.4%; vs 10.1%; p < 0.001), short interpregnancy interval, (13.0% vs 9.6%; p < 0.001), and low birth weight births (10.2% vs 8.7%; p = 0.003) than states where Medicaid provided comprehensive coverage. ConclusionsRestricting federal funds for abortion is associated with adverse outcomes. ImplicationsWhen Medicaid does not provide comprehensive coverage for abortion care, few abortions are provided and higher rates of adverse obstetrical outcomes are noted.

Improving Access and Equity in a Post-Dobbs World

Improving Access and Equity in a Post-Dobbs World

Explaining Feminist Movement Impact: Provincial Abortion Policies in the Wake of Decriminalization, 1988–2018

AbstractFocusing on four jurisdictions where abortion facilities and providers faced violent attacks following the Morgentaler decision of 1988, this study compares provincial government responses to core feminist demands in the area of women's reproductive health: enhanced hospital access, public funding of clinic abortions and safe zone protections. Consistent with previous research on childcare and anti-violence policies, the study finds that in neoliberal times, the presence of left governing parties in Alberta, British Columbia and Ontario generally favoured abortion rights interests while conservative regimes disadvantaged them. The article contributes valuable new insights in revealing (1) the importance of centrist leaders in Ontario and at the federal level to pro-choice policy changes, (2) the significance of feminist critical actors to these outcomes, and (3) major variation among New Democratic Party provincial governments on abortion policy. The conclusion discusses implications of these results and proposes directions for further research.

Chicago Abortion Fund

Chicago Abortion Fund

Travel for later abortion in the USA: lived experiences, structural contributors and abortion fund support

As abortion restrictions expand in the USA, pregnant people will continue to experience delays and be forced to travel for abortion. The study aims to describe later abortion travel experiences, understand structural factors influencing travel, and identify strategies to improve travel. This qualitative phenomenological study analyses data from 19 interviews with people who travelled at least 25 miles for abortion after the first trimester. Framework analysis used a structural violence lens. More than two-thirds of participants travelled interstate, and half received abortion fund support. Key considerations of travel include logistics, challenges during the journey, and physical and emotional recovery during and after travel. Restrictive laws, financial insecurity and anti-abortion infrastructure are forms of structural violence that created challenges and delays. Reliance on abortion funds facilitated access but also entailed uncertainty. Better resourced abortion funds could organise travel in advance, facilitate the travel of accompanying escorts, and tailor emotional support to reduce stress for those travelling. Clinical and practical support systems must be prepared to support people travelling for abortion, as later abortion and forced travel is increasing since the constitutional right to abortion in the USA was overturned. Findings can inform interventions to support the increasing number of people travelling for abortion.

Especificación de un modelo para el estudio de la elección reproductiva

Objetive: The discussion and specification of a model for the study of freedom of choice with respect to the termination of pregnancy was the objective of this document. Materials and Method: A documentary study was carried out with an intentional selection of sources indexed to Dialnet, Latindex, Publindex, Redalyc and Scielo from 1961 to 2019. Results: The research design limited the results to the literature consulted, suggesting the extension of the work based on the information published in Copernicus, Ebsco, Scopus and WoS. Conclusions: The research design limited the findings to the research scenario, suggesting the inclusion of the State as a funding and facilitator of safe abortion.

O12Barriers to abortion access for young southerners: a qualitative analysis of case notes from arc-southeast

<h3>Objectives</h3> Abortion funds have intervened to ensure young people can access safe, compassionate abortion care in the abortion-restrictive US Southeast. This study identifies barriers to abortion access and describes the obstacles young Southerners who seek abortion funding must navigate to inform strategies to reduce barriers to abortion care. <h3>Methods</h3> We conducted a secondary qualitative data analysis of case notes from people aged 21 or younger who resided in six Southeastern states and contacted the ARC-Southeast Healthline between May 2016 and May 2021 (n=2,278). Nine hundred and fifty information-rich case notes were selected for thematic analysis (n=950). <h3>Results</h3> The findings revealed that young Southerners encounter a multitude of barriers addressed by abortion funds within four primary categories: structural barriers, financial barriers, personal barriers, and the COVID-19 pandemic. Each type of barrier contributed to constrained bodily autonomy and delayed abortion care. Case notes also described the difficulties that youth seeking abortion care support navigate, which are scarcely documented in abortion access literature, such as pre-existing conditions, intimate partner violence, and immigration status. We conceptualized these findings into a framework synthesizing the challenges, impacts, and opportunities for abortion provision in the US Southeast. <h3>Conclusions</h3> The study findings suggest abortion funds serve a vital role in the disruption of structural violence imposed by Southern legislators to deter and delay youth from obtaining abortion care. To dismantle the systems of oppression that deny dignity and respect to young Southerners who seek abortion care, the best practices employed by abortion funds should be adopted to improve abortion care provision.

P017Experiences of indiana residents who traveled out of state to obtain abortion care: The role of abortion funds in restrictive states

<h3>Objectives</h3> Given Indiana's highly restrictive policy context with regard to abortion, and anticipated increases in restrictions, we aimed to measure residents' experiences traveling out of state for abortion care. <h3>Methods</h3> Between June 2021 and April 2022, we recruited pregnant people who lived in Indiana and were considering abortion through Google advertisements, abortion clinics, and abortion funds. Respondents completed a self-administered online survey at baseline and a second survey one month later. We analyzed characteristics and experiences of those who reported leaving the state to obtain abortion care. <h3>Results</h3> Among 213 participants who reported an abortion at endline, 56 (26%) left the state to obtain abortion care. These travelers were aged 15–39 with pregnancies from 6 to 31 weeks' gestation, 71% were parents; and 25 (45%) identified as Black, 23 (41%) as White, and five (9%) as multi-racial. Participants traveled to Illinois most commonly (70%), followed by Kentucky (12%), Ohio (4%), and two other states. The most common barriers experienced by travelers included gathering money (68%), traveling a long distance to the clinic (27%), taking time off (23%), not knowing where to go (21%), arranging childcare (20%), and having difficulty complying with waiting periods and gestational restrictions, and facing clinic protestors. Facilitators included financial support from an abortion fund (63%), easily accessible online information (43%), and financial support from a clinic-based abortion fund (30%). <h3>Conclusions</h3> As more Indiana residents are forced to leave the state for abortion care, investing in abortion funds and practical support services will be essential strategies for maintaining access to abortion care across state lines.

P034Who fails to obtain abortion care in indiana? Results from a longitudinal online survey

<h3>Objectives</h3> We aimed to measure barriers to accessing abortion care in Indiana, a state with hostile abortion policies that is anticipated to become even more restrictive. <h3>Methods</h3> Between June 2021 and April 2022, we recruited pregnant Indiana residents seeking abortion via Google advertisements and other online posts, as well as through abortion clinic waiting rooms and callers to local abortion funds. Participants completed a self-administered, online survey at baseline, and a follow-up survey approximately one month later to ascertain outcomes. We compared the proportion of people who reported an abortion at endline by recruitment method and social and economic barriers experienced, using chi-square tests of independence and multivariable logistic regression models. <h3>Results</h3> Overall, 351 participants completed the baseline survey and 205 (58%) participants completed endline. Among those recruited from Google ads, 46% had an abortion compared to 91% and 94% of participants recruited from an abortion fund or a clinic (p<0.01). Participants who reported experiencing abortion stigma — specifically, their family opposed abortion or they feared clinic protestors — (76% vs. 87%), who did not have paid jobs (76% vs. 88%), and were uninsured (65% vs. 86%) were less likely to have received an abortion than were those who did not report these experiences. <h3>Conclusions</h3> Anti-abortion sentiment and financial barriers prevented people from obtaining abortion care in Indiana, while abortion funds facilitated access. As abortion becomes increasingly restricted and likely clinically inaccessible in Indiana, facilitating connections to abortion funds and combating abortion stigma are critical strategies to ensure access to care.

P016Experiences of self-managed abortion in indiana: Financial barriers to clinical care and a need for information on self-managed medication abortion

<h3>Objectives</h3> We aimed to understand Indiana residents' experiences and preferences regarding self-managed abortion in a highly restrictive state. <h3>Methods</h3> Between June 2021 and April 2022, we recruited pregnant people who lived in Indiana and were considering abortion through Google advertisements, online posts, abortion clinics, and abortion funds. Respondents completed a self-administered online survey at baseline and a second survey one month later. We analyzed reported self-managed abortion experiences at baseline and endline, and characteristics of those who self-managed an abortion. <h3>Results</h3> Among 370 baseline respondents, 66 (18%) reported a preference for self-managed medication abortion over clinical care, while 33 (9%) participants reported an actual attempt to self-manage an abortion for the current pregnancy, and an additional four (1%) were in the process of self-managing. Most who self-managed identified as White (58%), 33% as Black, and 6% as Asian; and were aged 16–37, with pregnancies from 4 to 13 weeks' gestation. Sixteen (49%) respondents used herbs, six (18%) used misoprostol and/or mifepristone, six (18%) used other medications, two (6%) took emergency contraception after confirming the pregnancy, and 12 (37%) used other methods (eg, caffeine, physical exertion). At endline, 13 (3%) respondents reported ending their pregnancy using self-managed medication abortion. The most common reason given for self-managing an abortion was the inability to pay for clinical care. <h3>Conclusions</h3> Indiana residents need financial support to access clinical abortion care when that is their preference, and need information on safe, effective methods of self-managed medication abortion as an option, particularly in light of anticipated further restrictions on abortion access in the coming year.