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Background Intimate partner violence is common among women having abortions, with between 6% and 22% reporting recent violence from an intimate partner. Concern about violence is a reason some pregnant women decide to terminate their pregnancies. Whether risk of violence decreases after having an abortion, remains unknown.Methods Data are from the Turnaway Study, a prospective cohort study of women seeking abortions at 30 facilities across the U.S. Participants included women who: presented just prior to a facility¿s gestational age limit and received abortions (Near Limit Abortion Group, n¿=¿452), presented just beyond the gestational limit and were denied abortions (Turnaways, n¿=¿231), and received first trimester abortions (First Trimester Abortion Group, n¿=¿273). Mixed effects logistic regression was used to assess the relationship between receiving versus being denied abortion and subsequent violence from the man involved in the pregnancy over 2.5 years.ResultsPhysical violence decreased for Near Limits (adjusted odds ratios (aOR), 0.93 per month; 95% Confidence Interval (CI) 0.90, 0.96), but not Turnaways who gave birth (P¿<¿.05 versus Near Limits). The decrease for First Trimesters was similar to Near Limits (P¿=¿.324). Psychological violence decreased for all groups (aOR, 0.97; CI 0.94, 1.00), with no differential change across groups.Conclusions Policies restricting abortion provision may result in more women being unable to terminate unwanted pregnancies, potentially keeping them in contact with violent partners, and putting women and their children at risk.
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... This stress may be compounded by other external factors, including navigating substantial structural determinants to obstetric care and residing in the historical and contemporary sociopolitical context of the United States, resulting in added psychosocial strains on the pregnant person. In addition, research demonstrates being unable to access wanted abortion services increases the risk of physical violence from the male involved in the pregnancy and experiences of anxiety and poor self-esteem for the pregnant person, all of which contribute to prenatal stress (Biggs et al., 2017;Roberts et al., 2014). Thus, it is reasonable to hypothesize that restrictive abortion policies would be associated with poorer birth outcomes for pregnant people living in the United States. ...
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Background Since 2011, U.S. states have enacted more than 400 policies restricting abortion access. As structural determinants, abortion policies have the potential to influence maternal and child health access, outcomes, and equity through multiple mechanisms. Limited research has examined their implications for birth outcomes. Methods We created a state-level abortion restrictiveness index composed of 18 restrictive abortion policies and evaluated the association between this index and individual-level probabilities of preterm birth (PTB) and low birthweight (LBW) within the United States and by Census Region, using data from the 2005–2015 National Center for Health Statistics Period Linked Live Birth-Infant Death Files. We used logistic multivariable regression modeling, adjusting for individual- and state-level factors and state and year fixed effects. Results Among 2,500,000 live births, 269,253 (12.0%) were PTBs and 182,960 (8.1%) were LBW. On average from 2005 to 2015, states had approximately seven restrictive abortion policies enacted, with more policies enacted in the Midwest and South. Nationally, relationships between state restrictiveness indices and adverse birth outcomes were insignificant. Regional analyses revealed that a 1-SD increase in a state's restrictiveness index was associated with a 2% increase in PTB in the Midwest (marginal effect [ME], 0.25; 95% confidence interval [CI], 0.04–0.45; p < .01), a 15% increase in LBW in the Northeast (ME, 1.24; 95% CI, 0.12–2.35; p < .05), and a 2% increase in LBW in the West (ME, 0.12; 95% CI, 0.01–0.25; p < .05). Conclusion Variation in restrictive abortion policy environments may have downstream implications for birth outcomes, and increases in abortion restrictions were associated with adverse birth outcomes in three out of four Census Regions.
... It shows, contrary to 'abortion myths' associated with opposition to abortion (Berglas et al., 2017;Cates, 1982;Ralph et al., 2017;Swartz et al., 2020), that women who have abortions do not experience negative outcomes such as adverse mental health outcomes. In fact, women who have abortions tend, one year later, to be less prone to anxiety and low selfesteem, less likely to be tied to an abusive partner, and more likely to have aspirational life plans than their counterparts who were denied their right to choose (e.g., Biggs et al., 2017;Foster, 2020;Foster et al., 2018;Roberts et al., 2014). ...
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Margaret Atwood’s dystopian novel The Handmaid’s Tale ... portrays a theocracy that has been installed on the heels of a catastrophic collapse in human fertility.... Women who remain fertile are highly prized. They are also kidnapped, enslaved as ‘Handmaids’, and ritually raped in order to produce offspring for the leaders of the revolution. The regime’s Biblical justifications for this brutality may be hypocritical and paper-thin, but are Biblical all the same: its warped and extreme practices are cloaked in the legitimacy of old religious (and political) ideas... This chapter, through the lens of psychological science, examines much the same issues as The Handmaid’s Tale... We review evidence that motherhood has been reified across cultures, history, and prehistory. We argue that this reification is underpinned by some basic ideas about men’s dependence on women and the relative scarcity of women’s reproductive capacity. These ideas apparently venerate women, yet ensure their subordination. As moral patients, women’s interests are given lower priority than their foetus's or child’s. As moral agents, women’s choices are undermined (Ntontis, 2020), curtailed, and placed, to varying degrees, in the hands of others... We review recent and historical examples of these phenomena, before reviewing theoretical frameworks that help to explain the moral subordination of women during pregnancy, childbirth, and motherhood.
... We find that MCH/FP professionals' views on the role of abortion in their professional mission generally align with the state abortion policy environment in which they work. This finding suggests that despite robust evidence demonstrating the adverse MCH health and well-being impacts of pregnant people being unable to obtain abortions (Berglas et al., 2019;Foster et al., 2018aFoster et al., , 2018bJerman et al., 2016;Jones & Jerman, 2014;Ralph et al., 2019;Roberts et al., 2014), MCH and FP professionals in health departments may largely approach abortion as a political issue rather than from their professional public health perspectives. By contrast, participants in our study reported willingness to advocate for other controversial reproductive health activities and services, even in some restrictive policy environments. ...
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Introduction Prior research shows that maternal and child health (MCH) and family planning (FP) divisions in health departments (HDs) engage in some abortion-related activities, largely when legally mandated; some agencies also initiate abortion-related activities. Yet little is known about health department MCH/FP professionals’ views on how abortion-related work aligns with their professional mission. Methods Between November 2017 and June 2018, we conducted in-depth interviews with 29 MCH/FP professionals working in 22 state and local HDs across the U.S. We conducted inductive thematic analysis to identify themes regarding participants’ professional mission and values in relation to abortion-related work. Results Participants described a strong sense of professional mission. Two contrasting perspectives on abortion and the MCH/FP mission emerged: some participants saw abortion as clearly outside the scope of their mission, even a threat to it, while others saw abortion as solidly within their mission. In states with supportive or restrictive abortion policy environments, professionals’ views on abortion and professional mission generally aligned with their overall state policy environment; in states with middle-ground abortion policy environments, a range of perspectives on abortion and professional mission were expressed. Participants who saw abortion as within their mission anchored their work in core public health values such as evidence-based practice, social justice, and ensuring access to health care. Discussion There appears to be a lack of consensus about whether and how abortion fits into the mission of MCH/FP. More work is needed to articulate whether and how abortion aligns with the MCH/FP mission.
... Examining barriers to abortion care is important, as denying women* desired abortions may be associated with poorer maternal bonding, lower child development scores and greater economic insecurity. [1][2][3][4][5] Women who are denied a wanted abortion may experience more partner violence, 6 more anxiety, lower self-esteem, and less life satisfaction, 7,8 and have less aspirational life plans 9 compared to those who are successful in having a wanted abortion. Unintended pregnancies are associated with greater odds of having a low birth weight baby, and stillbirth or neonatal death may be more common. ...
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Despite a relatively permissive abortion law, women in the Netherlands encounter difficulties in accessing abortion care. Little is known about their experiences. This study explores women’s experiences with (online) abortion services and relevant health professionals’ experiences delivering care, with the goal of identifying key barriers encountered by abortion-seekers in the Netherlands. An exploratory qualitative research design with a constructivist approach and an abbreviated grounded theory method was used. Interviews with 20 women who had had an abortion and 14 health professionals who provide abortion care, and 200 emails of women seeking abortion care through the non-governmental organisation Women on Web, were coded inductively and deductively (using the Candidacy Framework) thereby generating themes. Abortion-seekers faced barriers including: (i) burden of taboo, (ii) vulnerability (emotional, financial, and social), (iii) health professional evaluation and (iv) disempowerment and distress. The overarching theme was women’s lack of autonomy in access to abortion care. The key barriers to abortion access in the Netherlands are the institutionalisation of taboo in abortion law and care, complex candidacy regulations, lack of permeability for certain marginalised groups, and women’s inability to speak openly about abortion. To increase the permeability of abortion care, and thereby women’s autonomy, legislators and policy-makers must trust women to make their own reproductive decisions and avoid actions that stigmatise abortion and hinder access to care, while actively developing systemic support for vulnerable groups.
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Integration of anti-oppression approaches into clinical practice, including sexual and reproductive health, is needed. Reproductive coercion is a common form of violence that directly impacts sexual and reproductive health. Person-centered harm reduction strategies for reproductive coercion can be integrated readily into routine care utilizing clinicians’ existing skill set. Interventions for reproductive coercion may serve as a proof of concept for the incorporation of anti-violence and healing justice efforts within medical care.
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The upcoming U.S. Supreme Court decision in Dobbs v. Jackson Women's Health Organization has the potential to eliminate or severely restrict access to legal abortion care in the United States. We address the impact that the decision could have on abortion access and its consequences beyond abortion care. We posit that an abortion ban would, in effect, mean that anyone who becomes pregnant, including those who continue a pregnancy and give birth to healthy newborns and those with pregnancy complications or adverse pregnancy outcomes will become newly vulnerable to legal surveillance, civil detentions, forced interventions, and criminal prosecution. The harms imposed by banning or severely restricting abortion access will disproportionately affect persons of color and perpetuate structural racism. We caution that focusing on Roe as a decision that only protects ending a pregnancy ignores the protection that the decision also affords people who want to continue their pregnancies. It overlooks the ways in which overturning Roe will curtail fundamental rights for all those who become pregnant and will undermine their status as full persons meriting Constitutional protections. Such a singular focus inevitably obscures the common ground that people across the ideological spectrum might inhabit to ensure the safety, health, humanity, and rights of all people who experience pregnancy.
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Most studies of abortion access have recruited participants from abortion clinics, thereby missing people for whom barriers to care were insurmountable. Consequently, research may underestimate the nature and scope of barriers that exist. We aimed to recruit participants who had considered, but failed to obtain, an abortion using three online platforms, and to evaluate the feasibility of collecting data on their abortion-seeking experiences in a multi-modal online study. In 2018, we recruited participants for this feasibility study from Facebook, Google Ads, and Reddit for an online survey about experiences seeking abortion care in the United States; we additionally conducted in-depth interviews among a subset of survey participants. We completed descriptive analyses of survey data, and thematic analyses of interview data. Recruitment results have been previously published. For the primary outcomes of this analysis, over one month, we succeeded in capturing data on abortion-seeking experiences from 66 individuals who were not currently pregnant and reported not having obtained an abortion, nor visited an abortion facility, despite feeling that abortion could have been the best option for a recent pregnancy. A subset of survey respondents (n = 14) completed in-depth interviews. Results highlighted multiple, reinforcing barriers to abortion care, including legal restrictions such as gestational limits and waiting periods that exacerbated financial and other burdens, logistical and informational barriers, as well as barriers to abortion care less frequently reported in the literature, such as a preference for medication abortion. These findings support the use of online recruitment to identify and survey an understudied population about their abortion-seeking experiences. Further, findings contribute to a more complete understanding of the full range of barriers to abortion care that people experience in the United States, and how these barriers intersect to not just delay, but to prevent people from obtaining abortion.
Article
The new Texas abortion law requires the physician to determine whether a fetal heartbeat is present and prohibits abortion after a heartbeat has been documented. An exception is allowed when a “medical emergency necessitated the abortion.” These and the other provisions of the statute are to be enforced through “civil actions” brought by private citizens. This paper identifies three populations of vulnerable women who will experience undue burdens created by the Texas abortion law. We begin with an account of the concept of undue burden in the jurisprudence of abortion, as expressed in the 1992 U.S. Supreme Court Case, Casey v. Planned Parenthood of Southeastern Pennsylvania. We then provide an evidence-based account of the predictable, undue burdens for three populations of vulnerable women: pregnant women with decreased freedom of movement; pregnant minors; and pregnant women with major mental disorders and cognitive disabilities. The Texas law creates an undue burden on these three populations of vulnerable women by reducing or even eliminating access to abortion services outside of Texas. The Texas law also creates an undue burden by preventably increasing the risks of morbidity, including loss of fertility, and mortality for these three populations of vulnerable women. For these women it is indisputable that the Texas law will create undue burdens and is therefore not compatible with the jurisprudence of abortion as set forth in Casey, because a “significant number of women will likely be prevented from obtaining an abortion.” Federal courts should therefore strike down this law.
Article
Introduction Georgia's 2012 House Bill 954 (HB954) prohibiting abortions after 22 weeks from last menstrual period (LMP) has been associated with a significant decrease in abortions after 22 weeks. However, the policy's effects by race or ethnicity remain unexplored. We investigated whether changes in abortion numbers and ratios (per 1,000 live births) in Georgia after HB954 varied by race or ethnicity. Methods Using Georgia Department of Public Health induced terminations of pregnancy data from 2007 to 2017, we examined changes in number of abortions and abortion ratios (per 1,000 live births) by race and ethnicity following HB954 implementation. Results After full implementation of HB954 in 2015, the number of abortions and abortion ratios at or after 22 weeks (from last menstrual period) decreased among White (bNumber = –261.83, p < .001; bRatio = –3.31, p < .001), Black (bNumber = –416.17, p < .001; bRatio = –8.84, p < .001), non-Hispanic (bNumber = –667.00, p = .001; bRatio = –5.82, p < .001), and Hispanic (bNumber = –56.25, p = .002; bRatio = –2.44, p = .002) people. However, the ratio of abortions before 22 weeks increased for Black people (bLessThan22Weeks = 44.06, p = .028) and remained stable for White (bLessThan22Weeks = –6.78, p = .433), Hispanic (bLessThan22Weeks = 21.27, p = .212), and non-Hispanic people (bLessThan22Weeks = 26.93, p = .172). Conclusion The full implementation of HB954 had differential effects by race/ethnicity and gestational age. Although abortion at 22 weeks or more decreased for all groups, abortion at less than 22 weeks increased among Black people. Additional research should elucidate the possible causes, consequences, and reactions to differential effects of abortion restrictions by race and ethnicity.
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The notion that abortion causes poor mental health has gained traction, even though it is not supported by research. Few studies have comprehensively investigated women's postabortion emotions. Baseline data from a longitudinal study of women seeking abortion at 30 U.S. facilities between 2008 and 2010 were used to examine emotions among 843 women who received an abortion just prior to the facility's gestational age limit, were denied an abortion because they presented just beyond the gestational limit or obtained a first-trimester abortion. Multivariable analyses were used to compare women's emotions about their pregnancy and about their receipt or denial of abortion after one week, and to identify variables associated with experiencing primarily negative emotions postabortion. Compared with women who obtained a near-limit abortion, those denied the abortion felt more regret and anger (scoring, on average, 0.4-0.5 points higher on a 0-4 scale), and less relief and happiness (scoring 1.4 and 0.3 points lower, respectively). Among women who had obtained the abortion, the greater the extent to which they had planned the pregnancy or had difficulty deciding to seek abortion, the more likely they were to feel primarily negative emotions (odds ratios, 1.2 and 2.5, respectively). Most (95%) women who had obtained the abortion felt it was the right decision, as did 89% of those who expressed regret. Difficulty with the abortion decision and the degree to which the pregnancy had been planned were most important for women's postabortion emotional state. Experiencing negative emotions postabortion is different from believing that abortion was not the right decision.
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Objectives: We examined the factors influencing delay in seeking abortion and the outcomes for women denied abortion care because of gestational age limits at abortion facilities. Methods: We compared women who presented for abortion care who were under the facilities' gestational age limits and received an abortion (n = 452) with those who were just over the gestational age limits and were denied an abortion (n = 231) at 30 US facilities. We described reasons for delay in seeking services. We examined the determinants of obtaining an abortion elsewhere after being denied one because of facility gestational age limits. We then estimated the national incidence of being denied an abortion because of facility gestational age limits. Results: Adolescents and women who did not recognize their pregnancies early were most likely to delay seeking care. The most common reason for delay was having to raise money for travel and procedure costs. We estimated that each year more than 4000 US women are denied an abortion because of facility gestational limits and must carry unwanted pregnancies to term. Conclusions: Many state laws restrict abortions based on gestational age, and new laws are lowering limits further. The incidence of being denied abortion will likely increase, disproportionately affecting young and poor women.
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The current political climate with regards to abortion in the US, along with the economic recession may be affecting women's reasons for seeking abortion, warranting a new investigation into the reasons why women seek abortion. Data for this study were drawn from baseline quantitative and qualitative data from the Turnaway Study, an ongoing, five-year, longitudinal study evaluating the health and socioeconomic consequences of receiving or being denied an abortion in the US. While the study has followed women for over two full years, it relies on the baseline data which were collected from 2008 through the end of 2010. The sample included 954 women from 30 abortion facilities across the US who responded to two open ended questions regarding the reasons why they wanted to terminate their pregnancy approximately one week after seeking an abortion. Women's reasons for seeking an abortion fell into 11 broad themes. The predominant themes identified as reasons for seeking abortion included financial reasons (40%), timing (36%), partner related reasons (31%), and the need to focus on other children (29%). Most women reported multiple reasons for seeking an abortion crossing over several themes (64%). Using mixed effects multivariate logistic regression analyses, we identified the social and demographic predictors of the predominant themes women gave for seeking an abortion. Study findings demonstrate that the reasons women seek abortion are complex and interrelated, similar to those found in previous studies. While some women stated only one factor that contributed to their desire to terminate their pregnancies, others pointed to a myriad of factors that, cumulatively, resulted in their seeking abortion. As indicated by the differences we observed among women's reasons by individual characteristics, women seek abortion for reasons related to their circumstances, including their socioeconomic status, age, health, parity and marital status. It is important that policy makers consider women's motivations for choosing abortion, as decisions to support or oppose such legislation could have profound effects on the health, socioeconomic outcomes and life trajectories of women facing unwanted pregnancies.
Conference Paper
Anecdotal reports that many women experience lasting psychological and emotional sequelae from abortion form the basis for abortion regulation in the US. Using data from a prospective study of 956 women seeking abortion, we compare the emotional responses of women obtaining an abortion close to clinics' gestational age limit (Abortion, n=452) to women who were denied an abortion because they were beyond the limit (Turnaway, n=182). Emotions were examined using Likert scales one week following the abortion or denial of abortion. Differences in emotions between groups, and factors associated with negative emotions, were assessed using regression analyses, accounting for clustered data. Women in both groups expressed a range of positive and negative emotions. Relief was the most felt emotion among women who had abortions (90%). Two-thirds of women obtaining an abortion felt guilt, and one-third felt regret. Turnaways felt more regret (OR=1.6, p≤0.01) and anger (OR=1.8, p≤0.001) and less relief (OR=0.1, p≤0.001) and happiness (OR=0.7, p<0.05) than those in the Abortion group; however they felt less guilt (OR=0.3, p≤0.001). One week after seeking abortion, 97% of women who obtained an abortion felt that abortion was the right decision; 65% of Turnaways still wished they had been able to obtain an abortion. Factors associated with negative emotions one week after an abortion were higher pre-pregnancy intention, difficulty deciding to seek abortion, perceived community stigma, and lower social support. Results suggest that restricting access to abortion among women with unintended pregnancies would not reduce experience of negative emotions.
Article
CONTEXTWhen a woman who seeks an abortion cannot obtain one, having a child may reshape her relationship with the man involved in the pregnancy. No research has compared how relationship trajectories are affected by different outcomes of an unwanted pregnancy.METHODS Data from the Turnaway Study, a prospective longitudinal study of women who sought abortion in 2008–2010 at one of 30 U.S. facilities, are used to assess relationships over two years among 862 women who had abortions or were denied them because they had passed the facility's gestational age limit. Mixed-effects models analyze effects of abortion or birth on women's relationships with the men involved.RESULTSAt conception, most women (80%) were in romantic relationships with the men involved. One week after seeking abortion, 61% were; two years later, 37% were. Compared with women who obtained an abortion near the facility's gestational age limit, women who gave birth had greater odds of having ongoing contact with the man (odds ratio at two years, 1.7). The odds of romantic involvement at two years did not differ by group; however, the decline in romantic involvement was initially slower among those giving birth. Relationship quality did not differ between groups.CONCLUSIONS Giving birth temporarily prolonged romantic relationships of women in this study; most romantic relationships ended soon, whether or not the woman had an abortion. However, giving birth increased the odds of nonromantic contact between women and the men involved throughout the ensuing two years.
Article
The literature on partners and abortion focuses on intimate partner violence (IPV) and risk for abortion, and partners' control of women's abortion decisions. This paper examines how partners figure in women's abortion decisions, and identifies factors associated with identifying partner as a reason (PAR) for abortion. Baseline data were used from the Turnaway Study, a longitudinal study among women (n = 954) seeking abortion at 30 U.S. facilities between 2008 and 2010. Mixed methods were used. Data were analyzed using thematic coding and logistic regression. Nearly one third of women reported PAR for abortion. Three most common partner-related reasons were poor relationships, partners unable/unwilling to support a baby, and partner characteristics that made them undesirable to have a baby with. Eight percent who mentioned PAR identified having abusive partners as a reason for abortion. One woman in this subgroup reported being pressured by her partner to seek abortion, whereas others in this subgroup sought abortion to end abusive relationships or to avoid bringing children into abusive relationships. Factors associated with identifying PAR for seeking abortion included race, education, partner's pregnancy intentions, relationship with man involved in the pregnancy, and experience of IPV. Women make decisions to terminate pregnancies considering the quality of the relationship with and potential support they will receive from the man involved. Even women who report IPV, who may be vulnerable to coercion, report their motivation for the abortion is to end an abusive relationship, rather than coercion into abortion.
Article
The Turnaway Study is designed to prospectively study the outcomes of women who sought-but did not all obtain-abortions. This design permits more accurate inferences about the health consequences of abortion for women, but requires the recruitment of a large number of women from remote health care facilities to a study a sensitive topic. This paper explores the Turnaway Study's recruitment process. From 2008 to 2010, the staff at 30 abortion-providing facilities recruited eligible female patients. Eight interventions were evaluated using multilevel logistic regression for their impact on eligible patients being approached, approached patients agreeing to go through informed consent by phone, and enrolled patients completing the baseline interview. After site visits, patients had roughly twice the odds of being approached by facility staff and twice the odds of then agreeing to go through informed consent. When all recruitment steps were considered together, the net effect of site visits was to increase the odds that eligible patients participated by nearly a factor of six. After the introduction of a patient gift card incentive, patients had over three times the odds of agreeing to go through informed consent. With each passing month, however, staff demonstrated a 9% reduced odds of approaching eligible patients about the study. Prioritizing scientific rigor over the convenience of using existing datasets, the Turnaway Study confronted recruitment challenges common to medical practice-based studies and unique to sensitive services. Visiting sites and communicating frequently with facility staff, as well as offering incentives to patients to hear more about the study before informed consent, may help to increase participation in prospective health studies and facilitate evaluation of sensitive women's health services.