Legal Abortion Research Articles

Women at crossroads: a qualitative study of induced abortion and violence in a Ghanaian region

Unsafe abortions contribute significantly to maternal mortality and morbidity in Ghana. To reduce this, in 1982 abortion laws in Ghana underwent reform to broaden the conditions under which abortion is accessed. Although, evidence in other contexts highlights the contribution of violence to women’s experience of unwanted pregnancy and abortion, such evidence is limited within the Ghanaian abortion literature. This study aims to fill that gap. Informed by phenomenology, interviews were conducted with 10 women who had experienced various forms of violence leading to unwanted pregnancy and unsafe abortions. Participants were recruited between June 2017 and March 2018 in the Ashanti region of Ghana where they sought hospital care for unsafe abortion related complications. Participants mentioned intimate partners as the main perpetrators of violence. Financial challenges were also identified as important in increasing women’s vulnerability to violence. Verbal abuse from health workers contributed to denying women access to safe abortion. This paper advances dialogue about the ways in which women’s experience of violence from intimate/non-intimate partners and healthcare workers impacts their overall abortion experience. It advocates the empowerment of women to enable them to leave violent relationships, and the retraining of health workers to enable them to adopt respectful and empathetic care practices.

Seeking abortion accompaniment: experiences and self-managed abortion preferences of hotline callers after abortion legalisation in Argentina

BackgroundUntil the legalisation of abortion in Argentina in 2021, the Socorristas en Red, a network of feminist collectives, provided support and information (‘accompaniment’) to people self-managing their abortion with medications....

(128) ABORTION AND THE MYTH OF THE HARM-FREE PREGNANCY

Abstract Introduction A comprehensive description of the impact of pregnancy and childbirth on the human body has never been published. All pregnancies pose an unquantifiable threat to one's health and childbirth has permanent, irreversible effects that are cumulative and often late-manifesting. This reality refutes the anti-abortion, pro-natalist claim that there is any such thing as an elective abortion. Objective Abortion access supports the fundamental human right to bodily autonomy and sexual self-determination, hence every abortion is performed in the service of the pregnant person's health. The neglect of these principles has allowed politically-motivated legislatures to introduce imprecise health exception language that does not acknowledge the actual impact of pregnancy and childbirth. Affirming that abortion is life-saving healthcare refutes the health exception fallacy. Methods Maternal mortality and morbidity statistics are flawed and incomplete. None of the standard measures adequately captures the effects of pregnancy, whether voluntary or forced, upon the health of the parturient or her community. This report elucidates the unpredictable and often unattributed morbidity associated with pregnancy and childbirth, and argues for a human rights approach to abortion policy. Results Abortion bans have downstream effects that negatively impact the care of all pregnancy-capable people and their communities. Allowing non-experts to legislate against evidence-based care creates confusion and leads to mistrust of the healthcare system. Gendered disinformation, gag rules, and criminalization of pregnancy all result in stigma and harm. Conclusions The cultural reluctance to seriously study the effects of pregnancy on health is linked to gender inequality and is correlated with restrictive abortion laws that violate ethical principles of beneficence and patient autonomy. Involuntary pregnancy is a major and preventable cause of human suffering that can be relieved with permissive abortion policies based on ethical and scientific standards of care. Disclosure No.

The impact of Dobbs v. Jackson on medical school applications

I examine the relative impact of the Dobbs decision – which allowed states to restrict abortion access – and find schools in states with abortion bans saw a 0.65% increase in the 2022 share of women’s applications and a 1.17% increase in the 2023 share, but no measurable changes in the out-of-state share in either year. This is plausibly driven by applicants interested in an OB/GYN specialty.

Transformative reproductive futures in Northern Ireland

A foundation of rights-based solidarity has fostered an environment of cooperation between LGBTQ+ (lesbian, gay, bisexual, transgender and queer) rights and reproductive justice in Northern Ireland (NI) following the introduction of equal marriage and the decriminalization of abortion in 2019. This article provides a grounded look at this reproductive justice organizing in NI as an example of transformative organizing for reproductive futures. The case study considers a conversation with two activists who have been central to this work. Emma Campbell coconvenor of Alliance for Choice and Danielle Roberts the coconvenor of Reclaim the Agenda and former Senior Policy and Development Officer of HERe NI. Reclaim the Agenda is a coalition of feminist, youth, LGBTQ+ and community organizations that connects and mobilizes women to promote feminist activism through education, campaigning and celebration. HERe NI is a community organization and registered charity based in Belfast that supports lesbian and bisexual women and their families across NI. Alliance for Choice campaigns for free, safe legal and local abortion access for everyone who needs it in NI. Together these groups approach reproductive justice using a framework informed by lesbian feminist organizing and an intersectional approach that views access to abortion as part of a broader understanding of gender justice inspired by Black-women led SisterSong through (1) cross-movement organizing (2) centering bodily autonomy and (3) trans affirming feminist approaches to navigating shifting language about gender. The case study will be of interest to those working provide abortion services in a queer-informed way, as well as those navigating the challenges of reforming abortion policy.

Attitudes, concerns, and perceptions of patients undergoing fertility treatments in an abortion restrictive state in the aftermath of the Roe v. Wade reversal.

To investigate the abortion views and reproductive concerns of current in vitro fertilization patients after the US Supreme Court Dobbs v. Jackson decision, which overturned the Roe v. Wade decision guaranteeing abortion access. This is a cross-sectional survey of English-speaking patients undergoing in vitro fertilization from January to November 2022 at a large academic institution in a state with restricted abortion care. Participants completed a 43-question electronic survey which measured feelings about abortion, future fertility treatments, and embryo disposition both quantitatively and qualitatively. Of 543 eligible patients, 267 (49%) consented to participate when called and were sent the survey. Of those, 180 (67%) completed it, resulting in a total completion rate of 33%. The majority believe abortion should be legal in the case of birth defects (90.8%) or rape or incest (90.3%). A significant proportion (91.4%) expressed concerns about abortion being illegal in the state that they receive infertility care. They reported some concern about making embryos (89.6%), controlling what happens to them (95.4%), and discarding them (94.4%). Patients wrote about their concerns with pursuing fertility treatments, fear of not having access to needed medical care, and the desire to remain close to states with less restrictive abortion laws. The evolving political landscape surrounding access to reproductive care has created significant concerns regarding legal regulation of these treatments and the disposition of embryos. By understanding patients' concerns, health care providers can more effectively advocate for the protection of fertility treatments and patients' autonomy in embryo disposition.

Developing a comprehensive abortion prevention program for couples based on I-change model: study protocol for a mixed method research

BackgroundIn countries where abortion laws are stringent, induced abortions are prevalent. The limited availability of abortion services within these regions amplifies the likelihood of maternal complications and mortality. Induced abortions represent a significant public health concern in Iran and are characterized by a multitude of intricate factors that remain largely unexplored. Gaps in knowledge persist pertaining to the influences driving induced abortion within the Iranian context. To adequately address the issue of induced abortion, it is imperative to discern the determinants that shape the decision-making process. The primary objective of this study was to design an intervention program focused on mitigating the occurrence of induced abortion within couples, with an emphasis on identifying the key factors that contribute to this phenomenon.MethodsThis study comprises three phases. In the first phase, a qualitative approach based on the I-change model will be employed to identify the factors influencing induced abortion. The second phase involves a systematic review to identify the determinants of induced abortion and strategies to prevent induced abortion. In the third phase, the outcomes of the qualitative approach and systematic review will be shared with experts and specialists using the Delphi method to categorize and prioritize strategies. Subsequently, based on the final consensus, a comprehensive program will be developed to prevent induced abortion.DiscussionThis study introduces an I-change model-based program for the prevention of induced abortion. The prevention of induced abortion holds great significance in mitigating maternal morbidity and mortality, curtailing healthcare expenses, and fostering population growth rates. The research findings will be disseminated via reputable peer-reviewed journals and communicated to the academic and medical communities. This dissemination aims to provide valuable insights that can contribute to the advancement of induced abortion and abortion prevention programs.

A Cross-National Examination of Abortion Politics: Contrasting Perspectives in the United States and France

The debate surrounding abortion laws has been one of great prominence in current politics. While some nations take a strong stance against the accessibility of the practice, others view it as an essential protection of women's autonomy. The main objective of this paper is to perform a comparative analysis of both the historical and contemporary legal landscape of abortion within France and the United States. Throughout this paper, the examination of the evolution of abortion laws in both countries are laid against a backdrop of shifting societal values, cultural influences, and political dynamics. In the United States, the narrative of abortion laws is marked by intense ideological complications and complex legal battles that result from deep rooted societal divisions. In contrast, Frances progression leaned towards growing liberalization, strongly influenced by public health priorities and an emphasis on gender equity. Through delving into key legal decisions, political movements, and public relations, this paper aims to illustrate the shaping legal and cultural frameworks within the two nations shape their respective policies and practices surrounding the topic of abortion. This paper highlights the implications of these divergent approaches towards womens reproductive autonomy, government health outcomes, and overarching societal norms. The comparative analysis of abortion within the two democracies seeks to provide insights into the underlying reasons for the stark differences in their approaches, striving to draw conclusions that may provide insight for future legal and policy initiatives in the realm of reproductive rights.

Post-Dobbs Psychiatric Exceptions in Abortion-Restricting States.

Mental disorders and suicide are important causes of increased morbidity and mortality rates during pregnancy. Since the U.S. Supreme Court's 2022 Dobbs decision, many state legislatures have passed stringent abortion bans and restrictions. These laws define exceptions under which abortion may be legally obtained. Suicidality and other psychiatric symptoms have been excluded from such definitions. In this column, the authors examine how legislatures, courts, and professional regulatory bodies in several abortion-restricting states have defined their medical emergency exceptions. The authors argue that psychiatrists should be concerned about the management of psychiatric emergencies during pregnancy as well as emerging legal intrusions into physician-patient decision making.

Landscape assessment of the availability of medical abortion medicines in India

BackgroundMedical abortion with mifepristone and misoprostol can be provided up to 63 days’ gestation in India. This accounts for 67.5 percent of all abortions in the country. We conducted an assessment to determine the availability of medical abortion medicines, specifically the combi-pack, in India.MethodsWe applied the World Health Organization landscape assessment protocol at the national level. The assessment protocol included a five-step adaptation of an existing availability framework, including online data collection, desk review, country-level key informant interviews, and an analysis to identify barriers and opportunities to improve medical abortion availability. The assessment was conducted between August and March 2021.ResultsMedicines for medical abortion are included in the national essential drug list and available with prescription in India. The assessment identified 42 combi-pack products developed by 35 manufacturers. The quality of medical abortion medicines is regulated by national authorities; but as health is devolved to states, there are significant inter-state variations. This is seen across financing, procurement, manufacturing, and monitoring mechanisms for quality assurance of medical abortion medicines prior to distribution. There is a need to strengthen supply chain systems, ensure consistent availability of trained providers and build community awareness on use of medical abortion medicines for early abortions, at the time of the assessment.ConclusionOpportunities to improve availability and quality of medical abortion medicines exist. For example, uniform implementation of regulatory standards, greater emphasis on quality-assurance during manufacturing, and standardizing of procurement and supply chain systems across states. Regular in-service training of providers on medical abortion is required. Finally, innovations in evidence dissemination and community engagement about the recently amended abortion law are needed.

Motivations for using misoprostol for abortion outside the formal healthcare system in Colombia: a qualitative study of women seeking postabortion care in Bogotá and the Coffee Axis

BackgroundIn 2006, a Constitutional Court ruling partially decriminalized abortion in Colombia, allowing the procedure in cases of rape, risk to the health or life of the woman, and fetal malformations incompatible with life. Despite this less prohibitive law, some women and pregnant people preferred self-managing their abortions outside the formal healthcare system, often without accurate information. In 2018, we undertook a study to understand what motivated women to self-manage using medications that they acquired informally. Colombia has since adopted a progressive law in 2022, permitting abortion on request through the 24th week of pregnancy. However, the implementation of this law is still underway. Examining the reasons why women chose to informally self-manage an abortion after 2006 may not only highlight how barriers to legal services persisted at that time, but also could inform strategies to increase knowledge of the current abortion law and improve access to services going forward.MethodsIn-depth interviews were conducted in 2018 with 47 women aged 18 and older who used misoprostol obtained outside of health facilities to induce an abortion, and who were receiving postabortion care in two private clinics. Interviews explored what women knew about the 2006 abortion law which was then in effect, and the reasons why they preferred informal channels for abortion care over formal healthcare services.ResultsWomen’s motivations to use misoprostol obtained outside the formal healthcare system were influenced by lack of trust in the healthcare system along with incomplete and inaccurate knowledge of the abortion law. Conversely, women considered misoprostol obtained outside the healthcare system to be effective, affordable, and easier to access.ConclusionsObtaining misoprostol outside the formal healthcare system offered a more accessible and appealing prospect for some women given fears of legal repercussion and stigma toward abortion. Though this preference will likely continue despite the more liberal abortion law, strategies should be implemented to broaden knowledge of the recent change in law and to combat misinformation and stigma. This would support knowledge of and access to legal abortion for those who wish to avail themselves of these services.

The woman is the active agent: General practitioners and the agentive displacement of abortion in Ireland.

After the legalization of abortion in 2018, Ireland needed clinicians to become abortion providers and make this political win a medical reality. Yet Irish doctors had next-to-no training in abortion care, and barriers ranging from stigma to economic pressures in the healthcare system impacted doctors' desire to volunteer. How did hundreds of Irish doctors make the shift from family doctor to abortion provider? Drawing on ethnographic research conducted between 2017 and 2020, this article explores the process by which Irish general practitioners became abortion providers, attending to the material impact of medical technologies on that journey. Drawing from medical anthropologists who have examined similar themes of agency, pharmaceuticals, and medico-legal frameworks within the topic of assisted dying, I build on Anita Hannig's idea of "agentive displacement" to frame the productive impact of abortion pills on this transition.

Induced Abortion and Out-of-State Travel Among Insured Women Before and After the Dobbs v. Jackson Women's Health Organization Decision

OBJECTIVE: To quantify changes in abortion rates and out-of-state travel for abortion among insured women before and after the Dobbs v. Jackson decision. METHODS: This was a cross-sectional analysis of IQVIA's anonymized, patient-level preadjudicated medical claims on induced medication or procedural abortions among 43.1 million insured women of reproductive age (15–49 years) in the United States. We used information from the Guttmacher Institute to stratify states based on post-Dobbs abortion access policy: 1) legal with protections, 2) legal with restrictions, 3) partial ban, and 4) full ban. The main outcomes were 1) total number and rate of abortions per 100,000 women of reproductive age and 2) proportion of women with out-of-state abortions before (July–December 2021) and after (July–December 2022) Dobbs. RESULTS: Between January 2021 and December 2022, a total of 212,875 women of reproductive age (mean±SD age 28.1±6.5 years) had at least one induced abortion. In a comparison of the pre-Dobbs period with the post-Dobbs periods, there were increases in both the total number of women with at least one abortion (from 54,634 to 57,017) and the rate of abortions (from 121.7 to 137.7/100,000). Increases in abortion rates were driven primarily by states where abortion is legal with protections (from 278.5 to 328.5/100,000), whereas abortion rates declined slightly in states with partial (from 16.1 to 15.0/100,000) and full (from 7.2 to 6.8/100,000) abortion bans. Increases in the percentage of women traveling out of state to obtain an abortion were observed only in restrictive states and were greatest in states with full abortion bans (27.4% before Dobbs to 53.4% after Dobbs) (P<.001). CONCLUSION: There was a modest increase in abortion rates among insured women nationally after Dobbs, with modest increases in abortions among residents of states with protective abortion policies and increases in out-of-state abortions among residents of full- and partial-ban states.

National Wounds and Gendered Harm: Reframing Abortion Pain in The Worst of Times

In light of abortion’s recurrent political centrality in the United States, examining abortion narratives remains critically urgent. This article analyzes the abortion narratives found in the 1993 anthology The Worst of Times compiled by Patricia G. Miller, which collects individual stories of illegal abortions from the post–World War II years. It analyzes these narratives in the context of the postwar period’s growing sensational political fascination with abortion pain, alongside the second-wave feminist positioning of abortion as the paramount feminist issue and inherent basis of feminist community. Against these discourses, the semi-anonymous narrators of The Worst of Times disrupt hierarchized, universal, and exclusionary models of pain. Rather, this article argues that, in constructing life writing centered around the painful experience of illegal abortion, the narrators’ experiences cohere into relational clusters that evince commonalities while also maintaining differences. In engaging with their painful abortion experiences, these narratives reshape the medical, national, and feminist power structures that attempted to define the pain that abortion signified. In a moment when abortion legislation faces continued assaults, these narratives invite a consideration of how the embodied, personal pain of abortion can facilitate creative models of community that rethink the power structures that restrict reproductive autonomy.

Methods for structural sexism and population health research: Introducing a novel analytic framework to capture life-course and intersectional effects

Accumulating evidence links structural sexism to gendered health inequities, yet methodological challenges have precluded comprehensive examinations into life-course and/or intersectional effects. To help address this gap, we introduce an analytic framework that uses sequential conditional mean models (SCMMs) to jointly account for longitudinal exposure trajectories and moderation by multiple dimensions of social identity/position, which we then apply to study how early life-course exposure to U.S. state-level structural sexism shapes mental health outcomes within and between gender groups. Data came from the Growing Up Today Study, a cohort of 16,875 children aged 9–14 years in 1996 who we followed through 2016. Using a composite index of relevant public policies and societal conditions (e.g., abortion bans, wage gaps), we assigned each U.S. state a year-specific structural sexism score and calculated participants’ cumulative exposure by averaging the scores associated with states they had lived in during the study period, weighted according to duration of time spent in each. We then fit a series of SCMMs to estimate overall and group-specific associations between cumulative exposure from baseline through a given study wave and subsequent depressive symptomology; we also fit models using simplified (i.e., non-cumulative) exposure variables for comparison purposes. Analyses revealed that cumulative exposure to structural sexism: (1) was associated with significantly increased odds of experiencing depressive symptoms by the subsequent wave; (2) disproportionately impacted multiply marginalized groups (e.g., sexual minority girls/women); and (3) was more strongly associated with depressive symptomology compared to static or point-in-time exposure operationalizations (e.g., exposure in a single year). Substantively, these findings suggest that long-term exposure to structural sexism may contribute to the inequitable social patterning of mental distress among young people living in the U.S. More broadly, the proposed analytic framework represents a promising approach to examining the complex links between structural sexism and health across the life course and for diverse social groups.

Ileal Evisceration Per Vaginum: A Serious Complication of Clandestine Abortions

Per vaginum evisceration through uterine perforation is a rare but potentially serious complication of clandestine abortion. early diagnosis and aggressive volume resuscitation enable major surgical management and reduce patient mortality. Serious complications include haemorrhage, infection and damage to surrounding organs (intestinal, urological). This is the report of two observations of evisceration per vaginum during a clandestine abortion by endo-uterine maneuver. The first patient, aged 20, nulliparous, presented to the emergency department with externalization of the bowel and ileal loop necrosis 3 hours after the abortion. In the majority of cases, surgical management is by laparotomy, but a laparoscopic procedure can be performed if the externalized viscera is the omentum. The post-operative course is straightforward, but the obstetrical prognosis remains guarded due to the sequelae of induced abortion. Despite efforts to raise young girls' awareness of the harmful effects of clandestine abortions and legislation against such practices, young girls are still being encouraged to undergo abortions with serious complications. Conclusion: we describe two cases of post-abortive intestinal evisceration, despite efforts to raise young women's awareness of the harmful effects of illegal abortions. Vaginal evisceration is a surgical emergency and treatment is mandatory without a diagnostic assessment. Efforts must be made to reduce the number of unsafe abortions.

The Texas Medical Board and the Futility of Medical Exceptions to Abortion Bans

This Viewpoint describes the failure of yet another state institution to generate meaningful guidance about medical exceptions to abortion bans.

Soberanas de nuestros cuerpos: networked framing of abortion legalization in Argentina

Abstract This study presents a critical discourse analysis (CDA) of the networked frames built in Twitter trending hashtags by proponents and opponents of abortion legalization in Argentina. The online discourses exemplified the dynamics of networked framing, where activists reshaped their framing of issues through crowdsourcing practices. While both sides focused their attention on defining violence and deservingness, the impact of abortion on democracy, and the appropriate geopolitical scope of the debate, they developed stark oppositional views. Supporters of legalization defined illegal abortion as state-sponsored violence against gestating people and highlighted transnational solidarities. On the other hand, pro-life users identified legal abortion as state-sponsored violence against the unborn and accused pro-abortion politicians of subverting the democratic rights of the pro-life majority. Both movements portrayed themselves as embodying reason and righteousness while projecting negative connotations onto their counterparts. Our findings provide a nuanced examination of the discursive work of Global South feminists whose advocacy shifted policy against formidable opposition.

High variability in self-pay pricing for vasectomy and vasectomy reversal in the United States.

In the United States (US) men who undergo vasectomy and/or vasectomy reversal (vasovasotomy) are likely to pay out-of-pocket for these procedures. We characterized the publicly disclosed pricing of both procedures with a focus on variability in self-pay prices. We queried all US hospitals for publicly disclosed prices of vasectomy and vasovasotomy. We assessed interhospital variability in self-pay pricing and compared hospitals charging high (≥75th percentile) and low (≤25th percentile) self-pay prices for either procedure. We also examined trends in pricing after the 2022 US Supreme Court decision that allowed individual states to ban abortion. Of 6692 hospitals, 1375 (20.5%) and 281 (4.2%) disclosed self-pay prices for vasectomy and vasovasotomy, respectively. There was a 17-fold difference between the 10th and 90th percentile self-pay prices for vasectomy ($421-$7147) and a 39-fold difference for vasovasotomy ($446-$17,249). Compared with hospitals charging low (≤25th percentile) self-pay prices for vasectomy or vasovasotomy, hospitals charging high (≥75th percentile) prices were larger (median 150 vs. 59 beds, p < 0.001) and more likely to be for-profit (31.2% vs. 7.8%, p < 0.001), academic-affiliated (52.7% vs. 23.1%, p < 0.001), and located in an urban zip code (70.1% vs. 41.3%, p < 0.001). From October 2022 to April 2023, the median self-pay price of vasectomy increased by 10% (from $1667 to $1832) while the median self-pay price of vasovasotomy decreased by 16% (from $3309 to $2786). We found large variability in self-pay pricing for vasectomy and vasectomy reversal, which may serve as a barrier to the accessibility of male reproductive care.

‘How Did You Get in There and Make the Law Work?’ Feminist Activism, Doctors and Abortion Law: The Occupation of an Hospital

In this article, I examine the aftermath of Italy's 1978 abortion law (Law 194/1978) and the following feminist occupation of a Rome hospital, revealing a little-known chapter in feminist history. The legislation marked a pivotal moment by partly legalising abortion access, overturning draconian laws from the Fascist era. The focus on the 3-month occupation illuminates how social movements actively shaped, and were shaped by, the implementation of the law. Drawing on overlooked archival materials and original interviews with feminist abortion campaigners, I uncover unique dynamics between feminist activists, medical professionals, and abortion law. I contend that this historical event not only diversifies our understanding of social movements’ roles in legal changes but also highlights the exceptional case of a public hospital serving as a platform for transmitting feminist practices and knowledge to medical professionals. Ultimately, I argue for the crucial role of feminist history in advancing socio–legal scholarship.