Legal Abortion Research Articles

Permissible People Smuggling and the Duty of Rescue: Insights from Backstreet Abortion

Migrant smugglers are portrayed as pure evil, driven only by greed, as they are blamed for the death and suffering of thousands of migrants. Similarly, backstreet abortionists have been the object of universal condemnation. Yet they are the only hope and means for refugees and women when border crossing and voluntary interruptions of pregnancy are not legally available. Drawing on the analogy with backstreet abortion, in the first part of this article I argue that migrant smuggling is justified in the context of a systemic violation of the human right to seek refuge (e.g. criminalisation of border crossing and SAR operations), provided that a number of procedural constraints are met. In the second part of this article, I go one step further and argue that under the extremely non-ideal conditions outlined above, smuggling becomes a humanitarian, and therefore cost-related, duty which binds organisations, whereas it only indirectly applies to individuals.

Strengthening the Provision of Abortion and Sexual and Reproductive Health Care Post-Dobbs: An Initiative of the Philadelphia Department of Public Health

The U.S. Supreme Court decision on Dobbs v. Jackson Women’s Health has had a disruptive impact on not only the patients who seek reproductive health care, abortion care providers, and abortion care–adjacent organizations, but has also sparked a need for public health departments to take on new roles to support their communities. In the wake of that 2022 decision, the Philadelphia Department of Public Health launched an ongoing initiative to increase support for the provision of abortion and sexual and reproductive health care. The authors describe the effort, which started with a landscape analysis and qualitative interview analysis to understand the needs and concerns of those comprising the abortion care delivery system in Philadelphia. The authors found that the immediate, short-term needs to support the local abortion care delivery network included funding for patients seeking abortion care, plus communication and education to counter misinformation about the legality of abortion in Pennsylvania. Through the initiative’s research efforts, the authors also found that long-term needs included care capacity–building and health systems–strengthening by removing non–evidence-based restrictions on abortion access and care. Another ongoing role for public health systems is to address and avert legislative or regulatory efforts to impose restrictions to Medicaid coverage for abortion services or other impediments that would disrupt the ability or capacity of health care providers to deliver comprehensive reproductive care. Today, public health departments are uniquely suited to address and mitigate the emerging post-Dobbs chilling effect on both patients and clinicians who may fear legal, professional, or personal consequences as they navigate options for appropriate, evidence-based reproductive health care, even in states where abortion remains legal.

Towards a rights-based approach for disabled women's access to abortion.

This article adds to the still limited scholarship on the impact of abortion laws and policies on people with disabilities and those with diminished capacity who seek abortion. We argue that neither the legal nor policy framework currently operating in England and Wales adequately incorporates and protects the rights of people with disabilities or those experiencing mental ill-health. Rather, the law and policy framework jeopardizes their reproductive agency. We argue that greater attention to and incorporation of standards contained within the UN Convention on the Rights of Persons with Disabilities (including the sources produced by its Committee) and implementation of guidelines produced by the World Health Organization would result in a rights-affirming framework that supports disabled women's reproductive agency, enhances their effective enjoyment of human rights, and supports them in accessing quality abortion care.

Evaluating Item Response Format and Content Using Partial Credit Trees in Scale Development

Abstract The type of response options selected for items on a survey, along with how many response options to include and whether to allow neutral midpoints, impacts data obtained from survey collections and the interpretations made using the results. Further, if subgroups within a population (e.g., racial/ethnic, gender, age) interpret response options differently, this variance can artificially inflate non-significant differences or mask true differences between groups. In this study, we apply two recursive partitioning procedures for investigating differential item functioning (DIF) in an experiment evaluating seven item response formats (five levels of an agree–disagree [AD] format and two levels of an item-specific [IS] format). Partial credit tree procedures allow for the evaluation of multiple covariates without prespecifying subgroups to be compared. We applied the procedures to items measuring adults’ attitudes toward legal abortion and all response formats functioned without DIF for age, gender, race, education, and religion when evaluated using global DIF screening approaches. Item-focused analyses indicated that odd-numbered response formats were less susceptible to content-based DIF. The combination of psychometric properties indicated that five-point AD and IS formats may be preferable for abortion attitude measurement based on the screening procedures conducted in this study.

The abortion trend after the pronatalist turn of population policies in Iran: a systematic review from 2005 to 2022

ObjectiveGiven Iran’s recent shift towards pronatalist population policies, concerns have arisen regarding the potential increase in abortion rates. This review study examines the trends of (medical), intentional (illegal), and spontaneous abortions in Iran over the past two decades, as well as the factors that have contributed to these trends.MethodsThis paper reviewed research articles published between 2005 and 2022 on abortion in Iran. The study employed the PRISMA checklist for systematic reviews. Articles were searched from international (Google Scholar, PubMed, Science Direct, and Web of Science) and national databases (Magiran, Medlib, SID). Once the eligibility criteria were applied, 42 records were included from the initial 349 records.ResultsAbortion is influenced by a variety of socioeconomic and cultural factors and the availability of family planning services. Factors that contribute to unintended pregnancy include attitudes toward abortion, knowledge about reproductive health, access to reproductive health services, and fertility desires, among others. In addition to health and medical factors, consanguineous marriage plays an important role in spontaneous and therapeutic abortion. A higher number of illegal abortions were reported by women from more privileged socioeconomic classes. In comparison, a higher number of medical and spontaneous abortions were reported by women from less privileged socioeconomic classes.ConclusionIranian policymakers are concerned about the declining fertility rate and have turned to pronatalist policies. From a demographic standpoint, this seems to be a reasonable approach. However, the new population policies, particularly, the Family Protection and Young Population Law, along with creating limitations in access to reproductive health services and prenatal screening tests as well as stricter abortion law could potentially lead to an increase in various types of abortions and their associated consequences.

Understanding Reproductive Rights of Women as Human Rights

Reproductive rights" are ultimately the rights of persons to decide whether to reproduce or not and have reproductive health. This shall include an individual's right to plan a family, use contraceptives, terminate a pregnancy, and get access to reproductive health services without unreasonable restrictions. The notion that women has the right to make their own choices & reproductive health decisions should be reflected not only in individual wants but also incorporated in the legal system. Human rights bodies have characterized restrictive abortion laws as a form of discrimination against women. India has made progress in the area of reproductive rights and legal abortion, which is backed up by constitutional provisions, legislative frameworks, and judicial wisdom

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.

Situation of Gender-Biased Sex Selection in Nepal

About 140 million women are believed to be "missing" around the world due to the result of son preference. Gender-biased sex selection (GBSS) in favor of sons is a manifestation of gender inequality that is deeply embedded in our society by tradition, culture, religion, social, economic and legal injustices that undervalue girls and women. This paper tries to discuss on the gender-biased sex selection (GBSS) in favor of sons. Similarly, the study is based on descriptive as well as analytical research design. The sources of information have been based on secondary data. The facts and figures have been presented into tabular form. Several districts showed significantly skewed sex ratio at birth (SRBs) at 110 or above with Kaski, Arghakhanchi and Bhaktapur, province one and Lumbini province having the highest SRBs in Nepal. Youngest age groups at the bottom under 30 years of 5year age groups of female population are low in 2021 census. The Nepali context makes pervasive use of sex-selection likely as strong son preference. Sons are seen as economic, social and religious assets and in some parts of the country while females are seen as a burden due to the expenses involved in marriage. Fertility decline means that couples feel pressure to bear a son at a low parity. The technology of sex-selective abortion is accessible to the Nepalis. Even though prenatal sex determination and abortion based on sex selection are prohibited and may incur severe penalties in Nepal under the current abortion law passed in 2002. Nepal provides abortion was legalized in 2002 and prior to that, there was no evidence of sex-selective abortion. SSA was made a punishable offence when exceptions for legal abortion were introduced by the eleventh amendment to the Nepal’s Muluki Ain in 2002. Consequences of the ‘missing females’ become long term demographic impact and also result in ‘excess males’ who struggle to marry in society.

Abortion, decriminalisation and the medico-legal paradigm

The medico-legal paradigm enmeshes legal with medical power, making abortion lawfully available only under the supervision of medical professionals. This article examines the recent parliamentary debates over abortion decriminalisation in New South Wales, Australia's most populous state, to argue that the decriminalisation of abortion in Australia represents a continuance with, rather than a break from, the medico-legal paradigm. The medical power embedded in laws that criminalised abortion in the nineteenth century, and liberalised abortion in the twentieth century, was not the same as that imagined by parliamentarians debating decriminalising abortion in the twenty-first century. Norms constituting abortion seekers and their doctors have shifted significantly. Nevertheless, the medico-legal paradigm continues to govern how lawful abortion is imagined. The medico-legal paradigm converts abortion seekers' desires for abortion into a need for healthcare and imagines the autonomy and agency of abortion seekers as enabled only through their subjection to medical power. This conversion, I suggest, dampens the potential abortion holds to open up and challenge norms of gender, sexuality and reproduction.

Between the Church and the State

Abstract Supranational cultural institutions and communities play an interesting role in the development of abortion policy both historically and today. In this article we consider two such institutions: the Catholic Church and the European community. The church is famously antiabortion, and we describe the ways in which the Catholic position manifests itself in different countries. Conversely, almost all European countries have liberal laws that allow abortion on demand for twelve weeks of pregnancy. Italy sits at the intersection of European and Catholic identities. Italy adopted European-style liberal abortion laws early, but Italians continue to identify with the church in surveys, which is one of the causes of high levels of conscientious objection by medical professionals. Italy’s abortion policy pleases neither Catholics nor secularists. We explain this by understanding Italy’s abortion law as liberal de jure, but its culture is still heavily influenced by Catholicism, resulting in limited abortion access de facto.

Doctors’ voices generate support for abortion care: Results from a nationally representative survey

ObjectiveWe tested abortion messaging to develop evidence-based communication recommendations for doctors who provide abortion care. Study DesignWe conducted an on-line survey in a nationally representative sample of 1,215 people, using NORC’s Amerispeak® Panel. We surveyed participants before and after viewing two brief videos featuring doctors who provide abortion care speaking about their work. Doctors’ comments were grounded in strategic communications and applied psychology research and emphasized caregiving roles, avoided political-sounding punditry, and acknowledged abortion’s complexities. We assessed participants’ characterizations of doctors who provide abortion care, how these characterizations impact support for abortion restrictions and overall views on abortion legality. We analyzed pre-post data using descriptive statistics, t-tests and multivariable regression. ResultsPost-messaging more participants endorsed positive descriptors of doctors who provide abortion care (p<0.001,t=8.99); fewer endorsed negative descriptors (p<0.001,t=10.32). Increased post-messaging endorsement of positive descriptors predicted declines in support for abortion restrictions (AOR = 1.69,p<0.01); decreased endorsement of negative descriptors did not. After messaging, 37% of respondents said their views of doctors who provide abortion care made them less likely to support abortion restrictions, compared to 14% before (p<0.001,t=-6.9). After messaging there was more overall support for legal, accessible abortion and less for abortion being mostly illegal (46%→48% and 24%→22%,p<0.001;t=-4.11). ConclusionsWhen doctors who provide abortion care use messaging recommendations that include speaking about abortion’s complexities and avoiding political-sounding punditry, they generate more support for legal abortion and less for restrictions. ImplicationsThe voices of doctors who provide abortion care shape abortion public opinion. When doctors speak from caregiving perspectives, avoid punditry, and acknowledge abortion’s complexities they generate more support for legal abortion and less for restrictions. However, audiences may not be aware a priori that ideas of doctors shape their views.

Knowledge and attitude towards current Ethiopian abortion law and its associated factors by abortion seeker women in Gedeo zone, Southern Ethiopia: Hospital-based cross-sectional study

IntroductionHuman rights laws defend the right to abortion. In Ethiopia, the 2005 abortion law permits termination in specific cases. Unsafe abortions account for 19.6 % of maternal deaths. ObjectiveAssessing knowledge and attitudes towards the current Ethiopian abortion law for women in Gedeo Zone, Ethiopia. MethodologyA cross-sectional study was undertaken in an institutional setting. We entered the data into Epi-Data version 4.6.0.2 and then exported it to SPSS Windows version 25. In bivariate logistic regression analysis, we included explanatory variables with a p-value < 0.25. In multivariable logistic regression analysis, we considered a p-value of 0.05, along with a 95 % CI, to be significant. A p-value of 0.05 and a 95 % CI are considered significant in the multivariable logistic regression analysis. The study employed AOR to establish the statistical association. ResultA study involving 398 individuals revealed that 61.3 % had good knowledge and 52.3 % favourable attitude toward the law. Married women were 3.91 times more likely to have good knowledge, can read and write were 8.29 times more likely to have a positive attitude. Housewives were 94 % less likely to have a good attitude. Women who recognized abortion complications were 3.11 times more likely to have a positive attitude, and sources of information were 2.62 times more likely to have a positive attitude. ConclusionRespondents show good knowledge and a positive attitude toward the current abortion law. However, there is still a need for further education and support for safe and legal abortion services.

The Legality of Abortion by Medical Personnel for Rape Victims in Indonesia: A Perspective from Maqashid Sharia by al-Syatibi and al-Tufi

This research aimed to analyze the legality of abortion by medical professionals for rape victims in Indonesia through the perspective of maqashid sharia. This study adopts a normative legal research approach, utilizing statutory interpretation (legal approach) and conceptual analysis (conceptual approach). The results of this study suggest that maqashid sharia emphasizes that abortions should not be performed arbitrarily and are only permissible in urgent situations that fulfill sharia objectives. This includes scenarios where the mother's life is at risk or serious medical conditions prevent the continuation of pregnancy. Such decisions should be made carefully, considering maslahah and mafsadat and involving consultations with medical experts and religious authorities. The maslahah principles elucidated by al-Tufi expand the flexibility in legal interpretation, allowing for Islamic law adaptation to contemporary needs and conditions. This is particularly relevant in abortion cases, where explicit guidance may not always be found in religious texts. Overall, the maqashid sharia approach to abortion underscores the importance of principles of justice, balance, and humanity in Islamic law. By considering all these aspects, Islamic law can provide relevant and adaptive guidance in addressing contemporary issues like abortion while remaining faithful to the primary objectives of sharia to achieve collective good and avoid harm. Penelitian ini bertujuan untuk menganalisis legalitas aborsi oleh tenaga medis bagi korban perkosaan di Indonesia melalui perspektif maqasid syariah. Penelitian ini merupakan penelitian hukum normatif, dengan menggunakan pendekatan peraturan perundang-undangan (legal approach) dan pendekatan konseptual (conceptual approach). Temuan penelitian ini menunjukkan bahwa ada ketegangan antara norma hukum yang ketat dan prinsip-prinsip maslahat dalam maqasid syariah yang mengutamakan kesejahteraan dan perlindungan terhadap korban perkosaan. Hasil penelitian ini menunjukan bahwa maqasid syariah menekankan bahwa aborsi tidak boleh dilakukan sembarangan dan hanya diperbolehkan dalam situasi mendesak dan memenuhi tujuan syariah. Ini termasuk situasi di mana kelangsungan hidup ibu terancam atau kondisi medis yang serius tidak memungkinkan kehamilan berlanjut. Keputusan tersebut harus diambil dengan hati-hati, dengan mempertimbangkan maslahah (barang publik) dan mafsadat (bahaya), dan melibatkan konsultasi dengan para ahli medis dan otoritas agama. Prinsip-prinsip mashlahah yang dijelaskan oleh al-Tufi memperluas fleksibilitas dalam interpretasi hukum, memungkinkan adaptasi hukum Islam dengan kebutuhan dan kondisi kontemporer. Ini sangat relevan dalam kasus aborsi, di mana tidak selalu ada panduan eksplisit dalam teks-teks agama. Secara keseluruhan, pendekatan maqasid syariah terhadap aborsi menggarisbawahi pentingnya prinsip-prinsip keadilan, keseimbangan, dan kemanusiaan dalam hukum Islam. Dengan mempertimbangkan semua aspek ini, hukum Islam dapat memberikan panduan yang relevan dan adaptif dalam menangani isu-isu kontemporer seperti aborsi, sambil tetap setia pada tujuan utama syariah untuk mencapai kebaikan bersama dan menghindari bahaya.

Reproductive rights legislation influences cardiothoracic surgery training options

ObjectivesTraining in cardiothoracic surgery coincides with a time when many plan their families. Many choose to delay childbearing until the end of training, 33% of women and 20% of men reported using assisted reproductive technology (ART). States have varying laws regarding abortion and ART, which can influence these decisions. Our purpose was to elucidate the intersection of such laws and the training positions available in cardiothoracic surgery. MethodsWe identified abortion laws, abortion laws regarding insurance coverage, personhood laws that potentially influence ART, and insurance coverage of ART using publicly available data. We created choropleth maps with cardiothoracic surgery training positions identified using the National Resident Matching Program Match data for 2024. ResultsWe found that 29.4% of cardiothoracic surgery programs (47 out of 160) are situated in states with abortion restrictions. Of 48 integrated training positions, 10 are in states with abortion restrictions. Similarly, 32 of 95 traditional thoracic positions and 5 of 17 congenital positions are in states abortion restrictions. A total of 25.6% of cardiothoracic training programs reside in states that grant personhood before birth, potentially affecting ART. Insurance coverage for abortion and ART are variable. ConclusionsValuing reproductive rights like access to abortion, insurance coverage, and ART can potentially influence training opportunities in cardiothoracic surgery.

US Obstetrician-Gynecologists’ Perceived Impacts of Post–Dobbs v Jackson State Abortion Bans

(Abstracted from JAMA Network Open 2024;7(1):e2352109) The US Supreme Court decision in the case of Dobbs v Jackson Women’s Health Organization (Dobbs) has had far-reaching consequences and implications for patients and for health care professionals. Between the announcement of the result of this case in 2022 and December 2023, 16 states, with 5 more pending, have passed bans on abortion with exceptions that in many cases are very limited.

Abortion Attitudes Across Cultural Contexts

Abstract: We explored between-country and within-country variability in abortion attitudes, using country-level factors (e.g., gender equality) and individual-level factors (e.g., gender role attitudes) as predictors. Participants from Mexico ( N = 215), India ( N = 215), the United States ( N = 215), and the United Kingdom ( N = 206) were recruited via Qualtrics Panels. Regression models and ANOVAs were used to assess whether estimates of gender inequality, gender role attitudes, motherhood norms, belief in big/moralizing gods, and sexual strategy were associated with abortion attitudes. As predicted, individuals living in countries with greater gender inequality, and more restrictive abortion policy, reported more restrictive abortion attitudes and stronger support for banning abortion. Furthermore, individuals who endorsed more traditional gender role ideologies, who reported belief in big/moralizing gods and who used long-term sexual strategies also reported more restrictive abortion attitudes and stronger support for banning abortion. Exploratory analyses highlight how these relationships vary as a function of cultural context. We can conclude that both contextual factors (e.g., local abortion legislation and gender inequality) as well as individual factors (e.g., gender role attitudes and religious/spiritual belief) shape people’s attitudes toward abortion. Implications regarding the bidirectional relationship between attitudes and policy in reproductive health are discussed.

Medical students' reproductive health perspectives: Pre- and post-Roe v Wade reversal.

The ability to make informed decisions about reproductive health is a cornerstone principle of the practice of prenatal medical genetics. Unfortunately, these reproductive health decisions have become entangled in the current, contentious political climate. This debate reached an inflection point in 2022 with Dobbs v. Jackson when the Supreme Court of the United States (SCOTUS) overturned the national right to abortion previously established in Roe v. Wade. This decision prompted a reassessment of the opinions of medical students on reproductive health and abortion. Our study focused on a medical school in Alabama, a conservative state that enacted a restrictive abortion ban following the Dobbs ruling. Two surveys, conducted in 2015 and 2022, explored students' viewpoints on reproductive health topics, including abortion. The comparison revealed a significant shift toward more pro-choice perspectives among medical students. Notably, religious affiliation did not consistently align with opinions, as many Christian students supported pro-choice views. Our results suggest that medical students' reproductive health opinions at our institution have shifted to a more pro-choice position over the last decade.

Leading a Healthcare Organization During a Period of Social Change: A Qualitative Study of Chief Executive Officers.

In recent years, organizational leaders have faced growing pressure to respond to social and political issues. Although previous research has examined the experiences of corporate CEOs engaging in these issues, less is known about the perspectives of healthcare leaders. To explore the experiences of healthcare CEOs engaging in health-related social and political issues, with a specific focus on systemic racism and abortion policy. Qualitative study using semi-structured interviews from February to July 2023. CEOs of US-based hospitals or health systems. One-on-one interviews which were audio recorded, professionally transcribed, and analyzed using thematic analysis. This study included 25 CEOs of US-based hospitals or health systems. Almost half were between ages 60 and 69 (12 [48%]), 19 identified as male (76%), and 20 identified as White (80%). Approximately half self-identified as Democrats (13 [55%]). Most hospitals and health systems were private non-profits (15 [60%]). The interviews organized around four domains: (1) Perspectives on their Role, (2) Factors Impacting Engagement, (3) Improving Engagement, and (4) Experiences Responding to Recent Polarizing Events. Within these four domains, nine themes emerged. CEOs described increasing pressure to engage and had mixed feelings about their role. They identified personal, organizational, and political factors that affect their engagement. CEOs identified strategies to measure the success of their engagement and also reflected on their experiences speaking out about systemic racism and abortion legislation. In this qualitative study, healthcare CEOs described mixed perspectives on their role engaging in social and political issues and identified several factors impacting engagement. CEOs cited few strategies to measure the success of their engagement. Given that healthcare leaders are increasingly asked to address policy debates, more work is needed to examine the role and impact of healthcare CEOs engaging in health-related social and political issues.

Use of Oral and Emergency Contraceptives After the US Supreme Court’s Dobbs Decision

The US Supreme Court Dobbs v Jackson Women's Health Organization decision allowed states to strengthen restrictions on abortion access, triggering the closure of family planning clinics and leading to confusion about the legality of emergency contraceptives (ECs). To evaluate the association between the Dobbs decision and fills for oral and emergency contraceptives in states that enacted the most restrictive abortion policies after Dobbs. This cohort study used data on contraceptive fills for women of reproductive age (15-49 years) in the US from IQVIA's National Prescription Audit PayerTrak and data from the Guttmacher Institute were used to categorize changes in abortion restrictions in each state. A difference-in-differences analysis compared changes in monthly fill rates for daily oral contraceptive pills (OCPs) and ECs in states that became most restrictive (implemented a full abortion ban after Dobbs) and comparison states (kept a medium level of abortion restrictions after Dobbs) before (March 2021 to November 2021) and after (July 2022 to October 2023) the Dobbs decision. State-level abortion restrictions. Monthly fills of OCPs and ECs per 100 000 women of reproductive age. Between March 2021 and October 2023, 142.8 million prescriptions for OCPs and 904 269 prescriptions for ECs were dispensed at US retail pharmacies. Before Dobbs, trends in monthly fill rates were similar for OCPs and ECs between the most restrictive and comparison states. After the Dobbs decision, states that became the most restrictive experienced an additional 4.1% decline in OCP fills with 285.9 fewer fills per 100 000 (95% CI, -495.8 to -6.8; P = .04). In contrast to OCPs, fills for ECs increased during the first year after Dobbs (July 2022 to June 2023) in both groups of states. However, 1 year after Dobbs (July 2023 to October 2023), the most restrictive states experienced an additional 65% decrease in emergency contraceptive fills with 13.2 fewer fills per 100 000 (95% CI, -27.2 to -4.1; P = .01). In this cohort study of prescriptions filled at US pharmacies, the Dobbs decision was associated with declines in oral contraceptives, particularly ECs, in states enacting the most restrictive abortion policies. Given the important role of OCPs and ECs in preventing pregnancy and the need for abortion, efforts to improve access may be needed, especially in states where legal abortion is no longer an option.

The 2023 Gerard W. Ostheimer Lecture. A Contemporary Narrative Review of Maternal Mortality and Morbidity: Opportunities to Improve Peripartum Outcomes.

The Gerard W. Ostheimer lecture is given annually to members of the Society for Obstetric Anesthesia and Perinatology. This lecture summarizes new and emerging literature that informs the clinical practice of obstetric anesthesiology. This is a narrative review of 2022 literature pertinent to maternal morbidity and mortality in all income settings globally. Themes associated with worse maternal mortality rate (MMR), challenges health care workers face, public health priority areas, and initiatives to help countries achieve the United Nations Sustainable Development Goal targets for MMR are discussed. MMRs are higher in low- and middle-income countries (LMICs) compared to high-income countries (HICs). Cesarean delivery rates are rising most rapidly in LMICs, warranting urgent maternal health care workforce planning efforts in these settings. Globally racial, ethnic, and geographical disparities in maternal mortality continue to be evident in global health care settings. In the United States, the MMR is rising. The evolving changes in abortion legislation in the United States may further negatively impact maternal morbidity and mortality. The need to implement American Society of Anesthesiologists-recommended obstetric anesthesia quality metrics to facilitate benchmarking and to improve patient experience and outcomes is discussed as well as the need for professional society guidance on minimum staffing levels in American labor and delivery units.