National Abortion Research Articles

“When you provide abortion services, you are looked upon as a bad guy”: experiences of abortion stigma by health providers in Nigeria

ABSTRACT Background Abortion stigma as reported globally has been inadequately documented empirically in Nigeria, Africa’s most populous country with a restrictive abortion law and a high rate of unsafe abortions. Objective The objectives of this study were to investigate the ways in which abortion stigma is experienced by Nigerian health professionals and how such experiences influence health professionals’ practice of safe abortion and post-abortion care. Methods The study utilized qualitative research consisting of in-depth interviews with 10 abortion providers. We elicited information with an open-ended interview guide that investigated the understanding of participants’ experiences of abortion stigma in Nigeria. The data were analysed qualitatively and thematically using Atlas.ti. Results The themes centred on perceptions and experiences of stigma among the providers interviewed. Participants’ experiences of abortion stigma included the following: being treated differently to other health professionals; experiencing disapproval and disrespect; name-calling and societal judgement; tagging and profiling of clinics by anti-abortionists; and social isolation. Participants attributed stigma to cultural and religious beliefs, the restrictive national abortion law, and pointed to hypocrisy. Some reported effects of stigma on providers included a feeling of insecurity, social exclusion, secrecy, and insincerity in clinical practice, discouragement, and guilt feelings. Despite the negative impacts, many respondents reported a sense of satisfaction stemming from their views that they were saving lives. Conclusion Systematic efforts to address these adverse factors could reduce the level of stigma experienced by providers, with a potential follow-through effect of improving women’s access to safe abortion care in Nigeria.

Nurse practitioner medication abortion providers in Canada: results from a national survey

BackgroundIn 2017, nurse practitioners (NPs) became the first non-physician healthcare providers authorised to independently provide medication abortion (MA) in Canada. We aimed to report on demographic and clinical characteristics of...

Trends over 50 years with liberal abortion laws in the Nordic countries.

During the 1970s the Nordic countries liberalized their abortion laws. We assessed epidemiological trends for induced abortion on all Nordic countries, considered legal similarities and diversities, effects of new medical innovations and changes in practical and legal provisions during the subsequent years. New legislation strengthened surveillance of induced abortion in all countries and mandated hospitals that performed abortions to report to national abortion registers. Published data from the Nordic abortion registers were considered and new comparative analyses done. The data cover complete national populations. After an increase in abortion rates during the first years following liberalization, the general abortion rates stabilized and even decreased in all Nordic countries, especially for women under 25 years. From the mid-1980s higher awareness about pregnancy termination led women to present at an earlier gestational age, which was accelerated by the introduction of medical abortion some years later. Most terminations (80-86%) are now done before the 9th gestational week in all countries, primarily by medical rather than surgical means. Introduction of routine ultrasound screening in pregnancy during the late 1980s, increased the number of 2nd trimester abortions on fetal anomaly indications without an overall increase in the proportion of 2nd relative to 1st trimester abortions. Further refinement of ultrasound screening and non-invasive prenatal diagnostic methods led to a slight increase in the proportion of early 2nd trimester abortions after the year 2000. Country-specific differences in abortion rates have remained stable over the 50 years of liberalized abortion laws.

“We need to confirm at least from two or three”: Healthcare workers’ discretion as gatekeepers in the context of the Ethiopian abortion law

IntroductionWomen’s access to legal and safe abortion is a vital means to reduce unsafe abortion, which in turn is known to reduce maternal morbidity and mortality. In 2005, Ethiopia enacted a relatively permissive abortion legislation. However, there is evidence that access to abortion care services may be challenging and controversial even if progressive abortion laws are in place. This article examines women’s access to abortion services from the perspective of healthcare workers in a rural setting in Ethiopia. Drawing on Lipsky’s theory of street-level bureaucrats, the article discusses healthcare workers’ discretion and the substantial authority they hold as gatekeepers to safe abortion services.MethodsThe study draws upon a qualitative, interpretative methodological approach, with in-depth semi-structured interviews with healthcare workers as the key method of data generation. The data was analyzed and interpreted thematically. Healthcare workers’ perspectives were examined with reference to the national abortion legislation and guidelines.ResultsThe findings reveal that healthcare workers make decisions on behalf of the women who seek abortion, and they involve parents and partners in abortion-related decision-making processes. Moreover, they assess the social context of the pregnancy such as the marital and economic statuses of the abortion-seeking women in ways that restrict women’s access to legally-endorsed abortion services.ConclusionsHealthcare workers’ practices in this rural area were found to challenge the basic provisions laid out in Ethiopia’s abortion legislation. Their negative discretion of the legislation contributes to the substantial barriers Ethiopian abortion-seeking women face in gaining access to legal abortion services, despite the presence of a progressive legal framework and guidelines.

Access for all: Research at the National Abortion Federation’s 47th Annual Meeting

Access for all: Research at the National Abortion Federation’s 47th Annual Meeting

Domestication of the Maputo Protocol in the Democratic Republic of Congo: Leveraging regional human rights commitments for abortion decriminalization and access.

The Maputo Protocol, adopted over 20 years ago, is a promising regional treaty for advancing gender equity and sexual and reproductive health and rights. This instrument has driven progress in women's health and rights across Africa, with much remaining to achieve to realize its full potential for women and girls, including access to safe abortion. The present paper shares the strategies and lessons from the Democratic Republic of Congo's (DRC) reform centered on the domestication of the Protocol, specifically applying its commitments on abortion decriminalization and access. With a vision of addressing maternal mortality and rectifying the impacts of widespread sexual violence against women during war, abortion as a human right and health imperative was at the heart of the DRC's reform. Governmental commitment, broad coalition building, evidence generation, and an intersectional advocacy agenda were critical to overcoming opposition, stigma, and other challenges. This paper shares key learnings from the DRC's complex yet collaborative reform strategies and its processes. The strategy prioritized domestication of the Protocol for numerous reforms, including paving the path to legal abortion on the broad grounds of rape or incest, and saving women's health and/or life. With a commitment to maximizing quality, access, task sharing, and equity, progressive national comprehensive abortion guidelines were created alongside an implementation roadmap for accountability. The DRC's experience leveraging the Maputo Protocol's obligations to advance abortion rights and access offers valuable insights for consideration globally.

Aborto e raça no Brasil, Pesquisa Nacional de Aborto 2016 a 2021

Abstract We examine racial differentials in abortion among women in Brazil using data from three editions of the Brazilian National Abortion Survey (PNA), 2016, 2019 and 2021. We test the difference in means in data from separate surveys, combined surveys without reweighting, and combined and reweighted surveys. We also use logistic models for the chance of having an abortion. The results indicate that there is a consistent racial differential in the three editions of PNA, with the percentage of abortions among Black women being higher than among white women. In the combined and reweighted surveys, among Black women of all ages the probability of having had an abortion is 11.03% while among white women it is 7.55%. This means a difference of 3.5 percentage points, which translates into a 46% higher probability for Black women, statistically significant values for a 5% interval. Logistic regressions produce similar results, with an average predicted probability of 12.61% for Black women and 8.90% for white women, also significant. Racial differences remain statistically significant for various combinations of PNA editions. However, in the separate surveys, the difference in means tests are only statistically significant in 2016. Black refers to the group formed by Black and Brown women (pretas and pardas). Due to the small sample size, it is not possible to say much about the differences with Asian and Indigenous women.

Abortion and race in Brazil, National Abortion Surveys 2016 to 2021

Resumo Examinamos a realização do aborto segundo cor ou raça das mulheres no Brasil usando dados de três edições da PNA, 2016, 2019 e 2021. Comparamos diferenciais raciais aplicando testes de diferenças de médias a dados de levantamentos separados, levantamentos combinados sem reponderação, e levantamentos combinados e reponderados. Na comparação usamos ainda modelos logísticos para a chance de realização de aborto. Os resultados indicam que há diferencial racial consistente nas três edições da PNA, com os percentuais de aborto entre as mulheres negras sendo mais elevados do que entre as mulheres brancas. Nos levantamentos combinados e reponderados, entre as mulheres negras de todas as idades a probabilidade de ter feito um aborto é de 11,03% enquanto entre as mulheres brancas é de 7,55%. Isso significa uma diferença de 3,5 pontos percentuais, que se traduz em uma probabilidade 46% maior para as negras, valores estatisticamente significantes para um intervalo de 5%. Regressões logísticas produzem resultados similares, com probabilidade média predita das mulheres negras de 12,61% e das mulheres brancas de 8,90%, também significantes. As diferenças raciais persistem estatisticamente significantes para várias combinações de edições da PNA. Porém, nos levantamentos isolados os testes de diferenças de média são estatisticamente significantes apenas em 2016.

Abortion Bans and Resource Utilization for Congenital Heart Disease: A Decision Analysis.

To investigate the implications of potential national abortion ban scenarios on the incidence of neonatal single-ventricle cardiac defects. A decision tree model was developed to predict the incidence of neonatal single-ventricle cardiac defects and related outcomes in the United States under four theoretical national abortion bans: 1) abortion restrictions in existence immediately before the June 2022 Dobbs v Jackson Women's Health Organization Supreme Court decision, 2) 20 weeks of gestation, 3) 13 weeks of gestation, and 4) a complete abortion ban. The model included incidence of live births of neonates with single-ventricle cardiac defects, neonatal heart surgery (including heart transplant and extracorporeal membrane oxygenation [ECMO]), and neonatal death. Cohort size was based on national pregnancy incidence and different algorithm decision point probabilities were aggregated from the existing literature. Monte Carlo simulations were conducted with 10,000 iterations per model. In the scenario before the Dobbs decision, an estimated 6,369,000 annual pregnancies in the United States resulted in 1,006 annual cases of single-ventricle cardiac defects. Under a complete abortion ban, the model predicted a 53.7% increase in single-ventricle cardiac defects, or an additional 9 cases per 100,000 live births. This increase would result in an additional 531 neonatal heart surgeries, 16 heart transplants, 77 ECMO utilizations, and 102 neonatal deaths annually. More restrictive gestational age-based bans are predicted to confer increases in cases of neonatal single-ventricle cardiac defects and related adverse outcomes as well. Universal abortion bans are estimated to increase the incidence of neonatal single-ventricle cardiac defects, associated morbidity, and resource utilization. States considering limiting abortion should consider the implications on the resources required to care for increasing number of children that will be born with significant and complex medical needs, including those with congenital heart disease.

A Geospatial Analysis of Abortion Access in the United States after the Reversal of Roe v Wade.

To investigate current abortion access in the United States based on geographic location and to forecast access according to the landscape of abortion care in the year after the Dobbs v Jackson Women's Health Organization decision. Addresses of abortion-providing clinics were identified using web-based directories from Planned Parenthood, the National Abortion Foundation, Abortion Finder, and Power to Decide. Using geographic coordinates and the OpenStreetMap road network, Valhalla's Isochrone application programming interface was used to calculate the areas within a 30-, 60-, and 90-minute driving distance from these clinics. The population of reproductive-aged women (15-49 years) in the tracts inside or outside the accessible areas was determined using the U.S. Census American Community Survey for 2020. Review of legislative and judicial actions for 2023 determined at-risk states. Clinic locations and laws are accurate as of June 2, 2023. The addresses of 750 abortion facilities were geocoded. Currently, 41.4% (30.8 million) of women do not have access to an abortion clinic within a 30-minute drive, and 29.3% and 23.6% do not have access within a 60-minute and 90-minute drive, respectively. When accounting for the combined population with no access, severely limited access, and at-risk of losing access, 53.5% of women do not have access within a 30-minute drive, and 45.6% and 43.0% do not have access within a 60-minute and 90-minute drive, respectively. Two of every five American women do not have access to an abortion facility within a 30-minute drive, and one in four lack access within a 90-minute drive. These proportions could significantly increase if access is restricted further with state bans proposed in 2023.

Seeking support for abortion care from national hotlines in Canada: Caller characteristics and call outcomes, 2019-2021.

Both the National Abortion Federation Canada and Action Canada for Sexual Health and Rights operate national toll-free hotlines that provide information, financial support, and travel assistance to abortion seekers. We aimed to characterize callers to both hotlines before and after the onset of the COVID-19 pandemic. Hotline personnel routinely document information about callers and type(s) of assistance needed and received. We received call logs from both organizations for a two-year period (April 1, 2019 through March 31, 2021). We exported these data to Microsoft Excel® and analyzed them using descriptive statistics. We analyzed case notes for content and themes. Over the study period, the two hotlines worked with 270 unique callers. Nearly two-thirds of callers (n = 174) were seeking support to obtain abortion care for pregnancies after 14 weeks gestation, including 69 callers (26%) who were at or beyond 24 weeks gestation. Most callers were seeking support to obtain abortion care outside of their province of residence because services at their gestational age were not available. Caller needs were similar before and after the onset of the pandemic, but fewer traveled to the United States for abortion care in the COVID-19 era. Assistance hotlines play an important role in helping some abortion seekers navigate the Canadian health system to obtain needed abortion care. The needs of those seeking care after the 14 weeks gestation points to gaps in current service availability. Identifying ways to expand later abortion care in Canada, particularly after 24 weeks, appears warranted.

Pesquisa Nacional de Aborto - Brasil, 2021

The National Abortion Survey 2021 (PNA 2021) utilized face-to-face structured interviews and a self-administered questionnaire placed in a sealed box to collect data on abortions in Brazil. Interviews were held with a nationally representative sample of 2,000 women, randomly selected from among literate women ages 18 to 39 residing in urban areas. We compared some of the results with previous waves of the survey, PNA 2010 and PNA 2016. Findings show that abortion is in decline but remains a major public health issue. Around 10% of the women interviewed in 2021 said they had had at least one abortion in their lives (compared to 15% in 2010). We estimate that nearly one in every seven women (15%) have had an abortion by the age of 40. We identified a decline in the proportion of women who needed to be hospitalized to finalize their abortions (55% in 2010; 43% in 2021; p = 0.003) and in the proportion of women who used medication for the abortion (48% in 2010; 39% in 2021; p = 0.028). Abortion is an event that generally happens early on in women's reproductive lives: the PNA 2021 found that 52% of women were 19 years old or younger when they had their first abortion. Higher rates were detected among respondents with lower educational levels, Black and Indigenous women, and women residing in poorer regions.

Resolute in the face of adversity: Research at the National Abortion Federation’s 46th Annual Meeting

Resolute in the face of adversity: Research at the National Abortion Federation’s 46th Annual Meeting

National abortion survey in Peru

National abortion survey in Peru

Structural barriers or patient preference? A mixed methods appraisal of medical abortion use in England and Wales

Although patient choice of abortion method is a key component of quality care, medical abortion (MA) has become the most common method (87%) in England and Wales, as in many countries worldwide. This research aimed to critically examine factors influencing the growth in MA use in England and Wales. Mixed methods were used, combining multi-level regression analysis of national abortion statistics (2011-2020) and key informant interviews with abortion service managers, commissioners, and providers (n=27). Overall trends have been driven by growth in MA use for abortions under 10 weeks in the private non-profit sector. Variation in MA use between patient sub-groups and regions has narrowed over time. Qualitative findings highlight health system constraints that have influenced the shift towards MA, including workforce constraints, infrastructure requirements, provider policies, cost, and commissioning practices involving under-funding and competition, which have caused the private non-profit sector to limit method choice across their services to remain financially viable. While removal of legal restrictions on MA has expanded choice, similar policy progress has not been seen for surgical methods. The study concludes that abortion method choice has been constrained by structural health system factors, with potential negative consequences for service acceptability, inequalities, and patient-centredness.

Perspectives on an early abortion ban in a restrictive US state: A qualitative exploration

ObjectivesTo gain a deeper understanding of perspectives on abortion and early abortion bans in a restrictive US state. Study designWe conducted a qualitative study using semistructured Zoom interviews with residents of the US state Georgia’s 6th Congressional District. Potential participants first completed a screening tool to recruit people who held “middle-of-the-spectrum” views on abortion based on two abortion questions on a 5-point Likert scale. The interviews focused on participants’ thoughts and feelings on abortion and Georgia’s early abortion ban. We transcribed, coded, and analyzed the interviews, and present a subset of themes. ResultsWe interviewed 28 people from March to May 2020. Participants often described holding complex views on abortion shaped by a range of lived experiences, values, and identities. They lamented the “black-and-white” nature of the national abortion discussion, which they felt oversimplified the issue and did not represent their views. Participants discussed the importance of experiences that allowed them to empathize with people who choose abortion, even when they personally felt they would make a different decision in a similar situation. Based on these experiences, many participants emphasized the importance of separating their own views on abortion from what needed to be regulated for others. However, participants often demonstrated a lack of understanding about the extent to which HB481 makes abortion inaccessible in Georgia. ConclusionsOur results indicate that, even in states traditionally labeled as restrictive or hostile towards abortion, many people express an openness to understand others’ experiences and hold complex and multifaceted views. ImplicationsOur laws and policies at the state level profoundly affect the practice of medicine and access to care. Our study furthers our understanding of how a sample of people in a restrictive US state think and feel about abortion and early abortion bans. These results can be used to support educational efforts, policies, and communication practices that better reflect the complex views of the public.

Revisiting the History of Abortion in the Wake of the Dobbs Decision.

Revisiting the History of Abortion in the Wake of the Dobbs Decision Kelly O’Donnell (bio) and Naomi Rogers (bio) In September 1977, Rosaura Jimenez, a twenty-seven-year-old Mexican American single mother in McAllen, Texas, went to the home of Maria Pineda for a surgical abortion. Pineda, a midwife, was licensed to deliver babies but not to perform abortions. After the procedure Jimenez developed sepsis; several days later she died of organ failure in the McAllen General Hospital. Her death would have been common and unremarkable a decade earlier, but since the Supreme Court’s 1973 Roe v. Wade decision, abortion had become legal and widely available in hospitals, clinics, and doctors’ offices across the United States. Jimenez had initially wanted a legal abortion and returned to a physician who had given her one eight months earlier, paid for by Medicaid. But in August the Hyde Amendment had gone into effect after the Supreme Court had judged it constitutional. Passed by Congress in the previous session, the amendment banned the use of federal funds for abortions and led states to restrict their funding of Medicaid as well. In McAllen Jimenez had been rebuffed by the physician, who said he would not be reimbursed, although she could find and pay for an abortion herself. Jimenez had a financial aid check in her purse to pay for her college classes (she was studying to become a special education teacher), but she chose access to education over access to legal reproductive care. After first traveling to Mexico where she received a cheaper but ineffective “hormone injection” from a pharmacy there, she sought Pineda’s aid.1 [End Page 1] Jimenez was quickly described as the first victim of the Hyde Amendment, a symbol that inspired rallies and candlelight vigils outside the state legislature in Texas and across the country. Eager to make this tragedy a potent lesson about the danger of antiabortion politics that could threaten the lives of every woman, feminist and Village Voice journalist Ellen Frankfort along with Frances Kissling, the director of the National Abortion Federation, came to McAllen in 1978. They believed that this death could become an issue that would unite feminists across class and race.2 Frankfort and Kissling, along with two of Jimenez’s friends, organized a sting operation to try to bring Pineda to justice. Setting up one woman with a wire and having Diana Rivera, another friend, pretend to need an abortion, the two white abortion activists waited in a station wagon with reporters from a Dallas television station. Pineda warned Rivera—as she had probably said to Jimenez—that if there were complications, she should say that her abortion was performed across the border in Mexico.3 The feminist visitors were then shocked to find that their race and status did not protect them from the arm of the law. Local police officers arrested not only Pineda but also Frankfurt, Kissling, and Rivera as potential “co-conspirators” in an illegal abortion.4 Texas’s weak medical practice law meant that although Pineda was found guilty of practicing medicine without a license, her misdemeanor offense resulted in three days in jail and a hundred-dollar fine. In 1979 Frankfort and Kissling published Rosie: The Investigation of a Wrongful Death and announced that 5 percent of the book’s royalties would be contributed to the new Rosie Jimenez Fund to provide financial assistance to poor women seeking abortions in Texas.5 [End Page 2] Jimenez remained a symbolic figure for American feminists seeking to protect access to abortion in the face of increasingly successful anti-abortion strategies that grew more creative and restrictive in the wake of the Hyde Amendment. As a poor Latina, Jimenez offered a way for white middle-class feminists to demonstrate cross-class, cross-racial support of reproductive health care in the face of the splintering of feminist organizations such as the Black Women’s Health Project and the National Latina Health Organization in the 1980s. A more holistic reframing of reproductive rights and reproductive justice was necessary to bring together disparate groups of feminists, especially around forced sterilization.6 Access to safe and legal abortion continued as a...

WITHDRAWN: Resolute in the face of adversity: Research at the National Abortion Federation’s 46th Annual Meeting

WITHDRAWN: Resolute in the face of adversity: Research at the National Abortion Federation’s 46th Annual Meeting

Research progress of laser caries prevention

Overview Caries is an infectious disease of chronic progressive destruction, mainly affected by a variety of factors of bacteria, if it cannot be treated timely, it gradually develops into a series of complications, such as endodontic disease and periapical disease, which affects the whole body health and reduces the quality of life of patients. The report of the fourth national oral health epidemiological survey shows that the caries rate of 12-year-old children's permanent teeth is 34.5% and the caries rate of 5-year-old children's milk teeth is 70.9%, which are 7.8 and 5.8 percentage points higher than the caries rate of the third national oral abortion respectively, and the caries rate is on the rise and the pattern is still serious. It is important to strengthen the oral health education, improve the caries prevention awareness of the public, and improve the caries prevention ability of dental hard tissues through certain measures to reduce the incidence of caries. In the past 30 years, the topical application of fluoride containing drugs and fluoride toothpaste has greatly reduced the prevalence of dental caries. However, the widespread application of fluoride has also increased the incidence of dental fluorosis and fluorosis bone disease. Laser caries prevention has good safety and convenient operation compared with other methods, and this paper will review the research on laser in caries prevention in recent years.

P023Adaptations to covid: Analysis of national abortion clinic survey data

<h3>Objectives</h3> To analyze changes in national abortion clinic practices and telehealth utilization during the COVID-19 pandemic. <h3>Methods</h3> We conducted descriptive analyses of nationwide abortion service trends utilizing a longitudinal survey distributed by the Society of Family Planning. The dataset comprised three surveys: T1 (February–March 2020), T2 (May–July 2020), and T3 (August–October 2020). Demographic characteristics including region (Northeast, Midwest, South, Midwest, and West) and type of clinic site (academic/hospital-affiliated, Planned Parenthood, and independent) were provided in the survey data. Wilcoxon rank sum and Kruskal-Wallis tests were utilized for statistical analysis. <h3>Results</h3> There was no difference in the volume of abortion services provided nationwide over T1–T3. However, there was a significant increase in the proportion of medical abortions compared to procedural abortions from T1 to T3 (26.7% to 40.0%, p<0.05). Planned Parenthood/independent sites performed a significantly greater proportion of medication abortions than academic/hospital-affiliated clinic sites (p<0.05) across all three time periods. There was no difference in utilization of telehealth across the time periods, even when controlling for type of site and region. Sites offering telehealth services did not experience changes in volume of abortions or in distribution of abortion services provided (medication vs. procedural). <h3>Conclusions</h3> An increase in the proportion of medication abortions compared with procedural abortions may suggest increasing access to medication abortion as clinics adapted to limitations of the COVID-19 pandemic. Utilization of telehealth did not appear to decrease the availability of operative procedures or volume of services, suggesting that telemedicine is a favorable care delivery option for clinics hoping to limit face-to-face interaction as the pandemic continues.