Women's Reproductive Autonomy Research Articles

Armed conflict, insecurity, and attitudes toward women's and girls' reproductive autonomy in Nigeria

BackgroundArmed conflict and insecurity have been linked to deteriorations in reproductive health and rights globally. In Nigeria, armed violence has taken a significant toll on women's and girls' health and safety. However, knowledge is limited about how conflict shapes attitudes surrounding their ability to make autonomous decisions on relationships and childbearing. Drawing on a socioecological framework and terror management theory, we aimed to investigate the association between conflict, insecurity, and attitudes toward women's and girls' reproductive autonomy in Nigeria. MethodsWe conducted a cross-sectional study using data from two sources: the World Values Survey (WVS) and the Uppsala Conflict Data Program-Georeferenced Event Dataset (UCDP-GED). Nationally representative data on attitudes of 559 men and 534 women was collected by WVS in 2017–2018. Linear probability models estimated the association between attitudes toward five dimensions of women and girl's reproductive autonomy (contraception, safe abortion, marital decision-making, delayed childbearing, early marriage), respondents' perceptions of neighborhood insecurity using WVS data, and geospatial measures of conflict exposure drawn from UCDP-GED. ResultsExposure to armed conflict and perceived neighborhood insecurity were associated with more supportive attitudes toward access to safe abortion among both men and women. Among women, conflict exposure was associated with higher support for contraception and the perception that early marriage can provide girls with security. Conflict-affected men were more likely to support a delay in girls’ childbearing. ConclusionOur findings suggest that conflict and insecurity pose a threat to, but also facilitate opportunities for, women's and girls' reproductive autonomy. Contraception, abortion, early marriage, and postponement or childbearing may be perceived as risk-aversion strategies in response to mortality threats, livelihood losses, and conflict-driven sexual violence. Our findings foreshadow changes in fertility and relationship patterns in conflict-affected Nigeria and highlight the need for health programming to ensure access to contraception and safe abortion services.

Temperature anomalies undermine the health of reproductive-age women in low- and middle-income countries

Climate change is expected to undermine population health and well-being in low- and middle-income countries, but relatively few analyses have directly examined these effects using individual-level data at global scales, particularly for reproductive-age women. To address this lacuna, we harmonize nationally representative data from the Demographic and Health Surveys on reproductive health, body mass index (BMI), and temporary migration from 2.5 million adult women (ages 15 to 49) in approximately 109,000 sites across 59 low- and middle-income countries, which we link to high-resolution climate data. We use this linked dataset to estimate fixed-effect logistic regression models of demographic and health outcomes as a function of climate exposures, woman-level and site-level characteristics, seasonality, and regional time trends, allowing us to plausibly isolate climate effects from other influences on health and migration. Specifically, we measure the effects of recent exposures to temperature and precipitation anomalies on the likelihood of having a live birth in the past year, desire for another child, use of modern contraception, underweight (BMI < 18.5), and temporary migration, and subsequently allow for nonlinearity as well as heterogeneity across education, rural/urban residence, and baseline climate. This analysis reveals that exposures to high temperatures increase live births, reduce desire for another child, increase underweight, and increase temporary migration, particularly in rural areas. The findings represent clear evidence that anthropogenic temperature increases contribute to temporary migration and are a significant threat to women's health and reproductive autonomy in low- and middle-income countries.

Women Reproductive Autonomy: Critical Analysis of Effictiveness and Implementation of MTP Act

Women Reproductive Autonomy: Critical Analysis of Effictiveness and Implementation of MTP Act

Social Egg Freezing for Single Women in China: Legal and Ethical Controversies.

Social egg freezing is an emerging topic in China, where single women currently face restrictions in accessing this service at medical facilities. Administrative regulations prohibit single women from accessing all forms of assisted reproductive technologies. Both the first lawsuit filed by a single woman seeking to freeze her eggs and a legislative proposal aiming to protect single women's rights to access assisted reproductive technologies were denied. This has sparked controversy and discussion about the reproductive rights of single women and the legitimacy of their access to medical and technical assistance. Laws and family planning policies related to women's reproductive rights in China have undergone dramatic changes in recent years, owing to shifts in population growth trends and societal attitudes toward marriage and childbirth, subsequently leading to a notable enhancement in women's reproductive autonomy. Meanwhile, factors such as marital status and career considerations have led to a delay in childbearing, triggering a growing need and advocacy for fertility preservation among single women. In China, the pursuit of social egg freezing by single women comes into conflict with the strict regulatory restrictions on assisted reproductive technologies. This study delves into the profound impacts of demographic changes, marital trends, fertility culture, and other social factors on female fertility in China. It also discusses the legislative issues and medical-social ethical concerns associated with the application of social egg freezing for single women. Additionally, this study offers regulatory suggestions aimed at enhancing women's reproductive health and autonomy, as well as the avoidance of potential ethical risks.

‘Here, the girl has to obey the family's decision’: A qualitative exploration of the tactics, perceived perpetrator motivations, and coping strategies for reproductive coercion in Bangladesh

Reproductive coercion (RC) undermines women's decision-making in reproductive health and negatively impacts women's health and well-being. This qualitative study explored RC in Bangladesh using in-depth interviews (IDIs) and focus group discussions (FGDs) with violence support centre clients, menstrual regulation (MR) and postabortion care (PAC) clients, and MR/PAC providers and pre- and post-procedure counsellors. All IDIs and FGDs were audio recorded, transcribed verbatim, and translated from Bangla to English for thematic analysis. RC was perpetrated primarily by male partners and in-laws and included both pregnancy-promoting tactics (such as contraceptive sabotage and forced continuation of an unwanted pregnancy) and pregnancy-preventing tactics (such as forced contraceptive use and forced MR). Threats and violence were tactics used for pregnancy-promoting and pregnancy-preventing RC. Perceived motivations for RC perpetration included family formation or dissolution, son preference, and a desire to maintain power or control over a woman. The primary motivator for contraceptive sabotage was concern about the safety and side effects of contraception, rather than pregnancy promotion. We classify this as contraceptive-related coercive control rather than RC due to the lack of pregnancy promoting intent. Women's responses to RC and contraceptive-related coercive control ranged from capitulation to active coping strategies such as covert use of contraception and MR, and enlisting providers' help to avoid forced MR. Differences in motivation for perpetration of RC and contraceptive-related coercive control call for distinct intervention strategies to support women's reproductive autonomy.

Paternity and Legal Abortion: A Comprehensive Analysis of Rights, Responsibilities and Social Impact

Introduction: The abortion debate in society revolves around women's reproductive rights and autonomy, while also considering men's perspectives and societal implications. Women argue for the right to make decisions about their bodies, emphasizing the potential consequences of denying this right, such as forced motherhood and restricted personal and professional development. Men, too, play a role in the debate, with some supporting women's rights and emphasizing the importance of joint decision-making in relationships. Development: The historical context of abortion is complex, with different societies and time periods featuring varying views and regulations. From ancient civilizations to modern eras, practices and legal approaches to abortion have evolved. In the Middle Ages, the Catholic Church had a significant impact on abortion regulation, while scientific and medical advancements shaped modern debates. Abortion is defined as the deliberate termination of pregnancy before fetal viability, with legal definitions varying worldwide. Understanding these distinctions is essential to address abortion comprehensively. In Argentina, the historic reform of 2020 marked a significant change in abortion legislation, permitting termination of pregnancy up to 14 weeks without justification. The feminist movement played a crucial role in advocating for this reform, leading to a more inclusive and equitable approach. Despite this progress, challenges remain, including ensuring nationwide access and promoting comprehensive sexual education. Responsible fatherhood involves recognizing men's rights and responsibilities in pregnancy and abortion. Men have the right to receive information, be present during pregnancy and childbirth, and establish custody and visitation arrangements. Emotional support, financial contributions, and active participation in decision-making are also essential aspects. Legislation regarding men's involvement in abortion decisions varies, but a balanced, informed dialogue is encouraged.Conclusions: Argentina's legalization of abortion represents a significant step forward for women's reproductive rights and autonomy. The Law on the Voluntary Interruption of Pregnancy recognizes fundamental rights and guarantees and establishes access to safe and legal abortion services. However, challenges persist in ensuring equal access across the country. Responsible fatherhood involves recognizing men's rights and responsibilities in pregnancy and abortion decisions.

Review of "Vibrant Matter: A Political Ecology of Things by Jane Bennett," Bennett, J. (2010). Vibrant Matter: A Political Ecology of Things. Duke University Press.

In Vibrant Matter: A Political Ecology of Things (2010), Jane Bennett encourages her readers to slow down the internal thoughts of human superiority over "intrinsically inanimate matter" --- thoughts that prevent them from "detecting...a fuller range of the nonhuman powers circulating around and within human bodies" and their political systems (p. ix). Some readers of CDQ may wonder why a book from 2010 is worth our attention in 2022. The COVID-19 pandemic, the U.S. Supreme Court's ruling on women's reproductive autonomy, and the restrictions placed on the EPA's control over carbon emissions all suggest a clear resurgence of what Bennett calls the oft-repeated "vitalism-materialism debate" (p. 90)---the debate over how far affect, agency, animacy, and vitality extend. Bennett resolves the tensions of that debate by fusing traditional ideas of mechanistic materialism with the notions of an unknowable agency in all matter (not just humans), an agency that lacks representation in current political thought. If technical communicators and designers dedicated to crisis/risk communication as well as those studying and producing political technologies (Cheek, 2021, 2022) didn't see the application of Bennett's "vital materialism" at the end of the Bush era's heated debates over stem cell research and the war in Iraq as well as the North American power blackout of 2003, then perhaps, given the current political climate, I can persuade them to find merit in revisiting Bennett's arguments.

The Rights of Man: Libertarian Concern for Men's, But Not Women's, Reproductive Autonomy

Libertarianism enshrines individual autonomy as its central political principle, but it has been criticized for applying this principle selectively. Reproductive decisions can stress the concept of individual autonomy by placing into conflict the claimed rights of each biological parent to choose. Two studies (N1 = 296; N2 = 580) show that among U.S. participants, libertarianism is associated with opposition to women's reproductive autonomy and support for men's. Libertarianism was associated with opposition to abortion rights and support for men's right both to prevent women from having abortions (male veto) and to withdraw financial support for a child when women refuse to terminate the pregnancy (financial abortion). Adjusting for the association between libertarianism and conservatism, only the relationship with opposition to abortion rights was rendered nonsignificant. Mediation analyses suggest that hostile sexism may account for libertarians' selective support for men's and not women's reproductive autonomy.

The impact of partner autonomy constraints on women's health-seeking across the maternal and newborn continuumofcare.

Gendered health inequities impede women's reproductive autonomy over the life course. Pregnancy is a critical time point for assessing inequities and partners are integral actors in the achievement or impediment of women's and children's health during this time. Among a nationally representative cohort of Ethiopian women 5-9 weeks postpartum with data collected from October 2019-September 2020, this study aimed to 1) understand the prevalence and interplay of partner-related autonomy constraints (intimate partner violence (IPV), reproductive coercion (RC), lack of encouragement from seeking antenatal care (ANC), and lack of encouragement from seeking postnatal care (PNC), and 2) examine the impact of autonomy constraints on the maternal and newborn health (MNH) continuum of care. Sixty percent of women experienced a partner-related autonomy constraint prior to or during pregnancy. Approximately 20% of women were not encouraged to seek antenatal care and postpartum care, respectively, whereas fewer women experienced IPV during pregnancy (12.3%) and RC (11.0%). Less than one in five women completed the MNH continuum of care. Lack of encouragement of ANC and PNC were associated with decreased care-seeking at every point across the MNH continuum of care. Lack of encouragement of ANC (aOR=0.45; p=0.05) and of PNC (aOR=0.16; p<0.001) were associated with reductions in completing the continuum. Partner engagement, interventions, and messaging are critical to enhance MNH care-seeking behaviors. This work was supported, in whole, by the Bill & Melinda Gates Foundation [INV 009466]. Under the grant conditions of the Foundation, a Creative Commons Attribution 4.0 Generic License has already been assigned to the Author Accepted Manuscript version that might arise from this submission.

The power of persuasion: Normative accountability and clinicians’ practices of contraceptive counseling

Efforts to reduce the incidence of unintended pregnancy by expanding access to and use of a new generation of long-acting reversible contraception (LARC) in recent years led to the wide-spread adoption of a tiered effectiveness (i.e., LARC-first) approach to contraceptive counseling in clinical practice. While reproductive justice scholar-advocates have critiqued this approach for how it may limit pregnancy-capable people's reproductive decision-making, less work in this area has examined efforts to prevent unintended pregnancy via contraceptive counseling as an interactional process shaped by social norms and inequities. Using individual interviews with clinicians working in obstetrics and gynecology that examined their approaches to contraceptive care delivery, this article draws on the sociological theory of interactional accountability to argue that clinicians hold their women patients accountable to social norms about pregnancy prevention in their attempts to persuade them to use LARC. Qualitative data analysis reveals that clinicians center their own contraceptive preferences and behaviors, prioritize pregnancy prevention via LARC use above other priorities patients may have, and communicate that contraceptive use is compulsory for women of reproductive age. By mobilizing their medical authority under the guise of achieving seemingly value-neutral public health goals, clinicians obscure the role that normative assumptions about reproductive behavior play in their practices of contraceptive counseling. By highlighting the strategies clinicians use to enact LARC-first contraceptive counseling as a normative accountability structure, this article demonstrates how these practices curtail women's reproductive autonomy and undermine ongoing efforts to achieve reproductive justice.

A Women's Rights-Based Approach to Reducing Child Mortality: Data from 193 Countries Show that Gender Equality does Affect Under-five Child Mortality.

Mother's health and wellbeing significantly affects child health. Women's autonomy can improve healthcare-seeking behaviour, utilisation of healthcare services, and planned pregnancy, thereby improving child health. The global under-five mortality rate (U5MR) has seen the fastest decline in the past two decades, but the influence of gender equality on child mortality remains unaddressed. A strategic approach addressing gender equality is needed to reduce the U5MR further. The study aimed to identify andinvestigate the association between indicators of gender equality and U5MR using a human rights-based approach. We analysed open-source secondary data from international agencies comprising 521 gender-sensitive variables for 193 countries. Nine variables were included for the final Structural Equation Model based on the theoretical model. Model 1 consisted of 193 countries, and Model 2 comprised a subgroup analysis of 11 variables for 158 countries. Gender equality was a latent variable, and the U5MR was the outcome variable. Gender equality was significantly associated with U5MR (Z = -7.47, 95% CI = -754.67 to -440.98, p < 0‧001, n = 193 for Model 1, and Z = -7.71, 95% CI = -808.26 to -480.72, p < 0‧001, n = 158 for Model 2). Female education, women's waged and salaried employment, women as employers, and women's representation in leadership and parliament enhanced gender equality, whereas the prevalence of child marriage and intimate partner violence (IPV) negatively affected gender equality. Improvement in gender equality significantly reduced U5MR. CONCLUSIONSFOR PRACTICE: Improving women's economic, educational, and social position and increasing female representation in higher leadership and policymaking positions is the key to reducing child mortality. Notably, eliminating child marriage and IPV is the key to achieving gender equality and is needed at the forefront of national policies. Gender equality can significantly improve women's reproductive autonomy, a critical factor in improving healthcare utilisation for women and their children.

Prevalence and characteristics of covert contraceptive use in the Performance Monitoring for Action multi-country study

ObjectivesA more nuanced understanding of contributors to covert contraceptive use remains critical to protecting covert users and reducing its necessity. This study aimed to examine the overall prevalence of covert use, and sociodemographic characteristics associated with covert vs overt use across multiple geographies in sub-Saharan Africa and Asia. Study DesignPerformance Monitoring for Action (PMA) is one of the few nationally representative surveys that measures covert use across socially diverse contexts via a direct question. Utilizing PMA 2019–2020 phase 1 data from Burkina Faso, Côte D'Ivoire, Kenya, Democratic Republic of Congo (DRC; Kinshasa and Kongo Central regions), Uganda, Nigeria (Kano and Lagos), Niger, and Rajasthan, we estimated overall prevalence of covert use. We conducted bivariate analyses and multivariate logistic regressions for 6 sites, comparing the odds of covert use with overt use among users of contraception by sociodemographic characteristics. ResultsCovert use ranged from 1% in Rajasthan to 16% in Burkina Faso. Marital status was the only sociodemographic characteristic consistently associated with type of use across sites. Specifically, polygynous marriage (compared to monogamous) increased odds of using covertly, ranging from adjusted odds ratio (aOR) of 1.8 [95% confidence interval (CI) 1.2–2.7] in Burkina Faso to 6.2 [95% CI 2.9–13.3] in Kinshasa. Unmarried women with partners or boyfriends were also more likely to be using covertly compared with their monogamously married counterparts in all sites (aORs ranged from 2.2 [95% CI 1.0–4.7] in Uganda to 4.4 [95% CI 1.7–11.0] in Kinshasa). ConclusionUnderstanding factors associated with covert use has programmatic and policy implications for women's reproductive autonomy. ImplicationsCovert use is a common phenomenon across most sites, representing a small but programmatically important contingent of users. Family planning providers and programs must protect access to and maintain privacy of reproductive services to this population, but should also focus on creating interventions and environments that support overt use.

Conscientious objection to abortion: how to strike a legal and ethical balance between conflicting rights?

The Italian Supreme Court ruling no. 18901 of May 13, 2021 has determined that doctors who are opposed to abortion can refuse to perform it on grounds of conscience, but such a refusal does not exempt them from providing assistance to the woman before and after the procedure itself. The legalization of abortion should be considered within a broader strategy to put an end to underground and unsafe abortions, to raise awareness and enhance reproductive education and accessibility to contraceptive methods. The authors have set out to briefly analyze the legal and ethical complexities inherent in the effort to reconcile women’s reproductive autonomy and freedom of choice with conscience-based refusal on the part of numerous healthcare professionals. Such an apparent conflict highlights the need for an ethically tenable solution that takes into account the dignity of unborn children, based on the conviction of many healthcare professionals primarily based on moral and religious tenets, that life begins at conception as well as the reproductive freedom and autonomy of women. (www.actabiomedica.it)

The prioritization and development of key social and structural indicators to address gaps in a framework for monitoring the Strategies toward Ending Preventable Maternal Mortality (EPMM): Results of an iterative expert technical consultation.

BackgroundSince 2014, iterative technical work has captured stakeholder demand and channeled it toward improving maternal health measurement, to support SDG 3.1. Strategies toward Ending Preventable Maternal Mortality (EPMM) (2015) turned a broad lens on upstream systemic determinants of maternal health and survival highlighted in 11 Key Themes. A monitoring framework was developed to help countries track progress across these domains. This process yielded requests for additional indicators where stakeholders identified gaps for tracking EPMM Key Themes. In response, two technical consultations aimed at affirming the measurement gaps, specifying the constructs for measurement, and fully elaborating the metadata to allow them to be monitored.MethodsMeasures for development were prioritized based on multi-stakeholder dialogues in five countries, and data collected from government officials and UN partners in twenty countries on perceived need for proposed additional indicators. Sixty-one participants representing expertise in measure development and the topical areas covered took part across both consultations. Measures were developed through two simultaneous participatory online consultations stratified by focus area, comprising videos, discussion forums, polls, and live Zoom meetings.ResultsEight candidate indicators relevant to priority recommendations in the EPMM Strategies are presented. Each includes a definition, numerator and denominator (if applicable), method of estimation, disaggregation factors, preferred data source(s), and expected periodicity. Four address gaps in measures of fundamental rights-related determinants of maternal health at national and subnational level, including women’s reproductive autonomy; participative accountability for maternal health outcomes; and Respectful Maternity Care. Four strengthen the ability to count, track, and link births and maternal deaths and causes of death.ConclusionsThe proposed indicators correspond to specific EPMM Key Themes, filling gaps identified by multiple stakeholders, and respond to calls for a broadened approach to measurement and for indicators that track the social and health-systems determinants of maternal health. They reflect inputs and aspirations of numerous stakeholders, gathered over time and across various platforms. The iterative, discursive exploration of the concepts for measurement and the need for metrics to track them responds to recent calls for measure development to be carried out in more inclusive ways, and to be primarily concept- and user-driven.

Women’s Vulnerability and State Responsibility in China’s Family-planning Policy

Reproductive vulnerability is a pervasive social issue that requires efforts from multiple government departments and social groups to solve. However, China has traditionally focused on the reproduction function of the family and marginalized women's reproductive autonomy and related rights. Based on the overview of the existing literature, we have a better understanding of the fertility experience of Chinese women when facing the fertility policy, focusing on their continued harm, neglect and vulnerability during the process of changes in the fertility policy. Through research, we can not only analyze the work-family dilemma that women have been in for a long time but also an in-depth analysis of low fertility intentions of Chinese women under the pronatalism policy. The vulnerability of Chinese women to childbearing is caused by the following factors: women’s socio-economic status, the concept of marriage and childbirth in society, the control of the national fertility policy, and the availability of fertility support system arrangements. We suggest the amendment of the family-planning policy should be accompanied by a series of arrangements for family support, such as establishing a reproduction-friendly environment, promoting social gender consciousness in all aspects, reducing women's household burden, and actively eliminating gender discrimination in the workplace. Then, women's reproductive vulnerability can be mitigated, and the gender structure can be balanced.

Reproductive justice: Non-interference or non-domination?

The reproductive justice movement started by black women's rights activists made its way into the academic literature as an intersectional approach to women's reproductive autonomy. While there are many scholars who now employ the term 'reproductive justice' in their research, few have taken up the task of explaining what 'justice' entails in reproductive justice. In this paper I take up part of this work and attempt to clarify the relevant kind of freedom an adequate theory of reproductive justice would postulate. To do so, I compare two approaches to reproductive freedom: an approach based on freedom as non-interference and an approach based on freedom as non-domination. I then argue that the non-domination approach better fits the ideals of the reproductive justice movement as set forth by its founders and should be treated as one of the necessary conditions in any non-ideal account of reproductive justice. Towards the end, I single out epistemic non-domination as crucial in shaping the narrative around reproductive justice.

Laboring for the State: Women, Family, and Work in Revolutionary Cuba, 1959–1971

Laboring for the State: Women, Family, and Work in Revolutionary Cuba, 1959–1971

Overcoming Ethical Challenges to Engaging Men Who Have Sex with Women in HIV Research.

Men who have sex with women are understudied in HIV research despite the extent to which they experience HIV-related mortality and contribute to the epidemic among women. During our experience of developing and piloting an HIV prevention intervention for men living with HIV in South Africa, and planning to have a child with an HIV-negative woman,ethical questions were posed regarding implementation of a male-centered intervention that did not require female partner participation. Two overarching ethical issues were the potential for (1) compromising women's reproductive and sexual autonomy and (2) increasing HIV-acquisition risks for the woman because the intervention efficacy was unknown. We describe here how these concerns were addressed to facilitate development of a male-centered HIV-prevention intervention. We hope this process manuscript will support researchers, clinicians, and reviewers to engage men who have sex with women in HIV prevention and care.

“When it comes to time of removal, nothing is straightforward”: A qualitative study of experiences with barriers to removal of long-acting reversible contraception in Western Kenya

ObjectiveBarriers to removal of long-acting reversible contraception (LARC) threaten reproductive self-determination, but their influence on contraceptive behaviors is not well understood. We describe perspectives of women in Western Kenya concerning LARC removal barriers. Study designWe used a qualitative descriptive approach with conventional content analysis to analyze transcripts for content and themes from eight focus group discussions (n = 55 participants) and one client journey mapping workshop (n = 9 participants) with women ages 18–49 in Western Kenya who were currently using or had formerly used contraceptives. FindingsOur primary themes concerned women's experience of LARC removal barriers and the impact on their behaviors and attitudes towards contraception. Women described providers being unwilling to remove LARC, regardless of rationale (including expiration, seeking pregnancy, or experiencing intolerable side effects) or demanding unaffordable fees. Women were reluctant to try LARC for fear of having to use the method for its entire lifespan even if they did not like it. Women saw LARC removal barriers as increasing their risk of unintended pregnancy through non-replacement of expired devices and fostering distrust in the health system. ConclusionBarriers to LARC removal may discourage utilization of LARC and contraceptive services generally, which can undermine women's efforts to achieve reproductive self-determination. ImplicationsOur findings affirm the importance of timely LARC removal to ensure that family planning programs uphold women's reproductive autonomy.

Insurance Churn and Inconsistent Access to Reproductive Health Care among Abortion Patients in Mississippi

Changes in health insurance coverage, or insurance churn, is common in the months surrounding pregnancy, but there has been limited study of how churn affects women's experiences with reproductive health care. We conducted in-depth interviews with women seeking abortion care in Mississippi in 2016. We coded interview transcripts relating to experiences accessing reproductive health care before pregnancy and organized the codes into themes. Of the 38 women interviewed, one-third were uninsured and half described recent changes in their health insurance. This contributed to inconsistent care, as women shifted from private clinicians while insured to health department clinics while uninsured. For several women, these shifts created barriers to contraceptive use and were closely related to their unintended pregnancy. Insurance churn and associated disruptions in contraceptive use were common among Mississippi women seeking abortion in this study. Policies should support women's reproductive autonomy by facilitating consistent coverage and reliable access to contraception.