Perceived abortion stigma and psychological well-being over five years after receiving or being denied an abortion.

OBJECTIVE:To prospectively assess perceptions of abortion stigma after receiving or being denied an abortion over 5 years, the factors associated with perceived abortion stigma, and the effects of perceived abortion stigma on psychological well-being. METHODS:We recruited people seeking abortion from 30 facilities across the US, and interviewed them by phone one week post-abortion seeking, then semiannually for 5 years. We used adjusted mixed effects regression analyses to examine the abortion stigma trajectories of those who obtained an abortion near a facility's gestational age limit (Near-limits) compared to those denied an abortion because they were just over the limit and carried their pregnancies to term (Turnaway-births). RESULTS:Of the 956 people recruited, we removed 28 due to ineligibility or missing data, leaving a final sample of 928. In unadjusted analyses, at one-week post-abortion seeking, over half of those seeking abortion perceived that if others knew they had sought an abortion, they would be looked down upon at least "a little bit" by people close to them (60%) or by people in their community (56%). In longitudinal adjusted analyses, people denied an abortion and who carried their pregnancies to term (Turnaway-birth group) reported significantly lower baseline perceived abortion stigma from people close to them (-0.38; 95% CI, -0.59, -0.16) and from people in their community (0.30; 95% CI, -0.52, -0.08), than Near-limits, differences that remained statistically significant for 1.5 years. Overall perceived abortion stigma declined significantly (p < .001) for both study groups. High perceived abortion stigma at baseline was associated with higher odds of experiencing psychological distress years later (adjusted Odds Ratio, 3.98; 95% CI, 1.39, 11.37). CONCLUSIONS:Most people considering abortion perceive some abortion stigma, which is associated with psychological distress years later

The State of the States: Targeted Regulation of Abortion Providers in 2013

The State of the States focuses on laws enacted in 2013 in four categories of abortion restrictions that the Center identifies as the most significant trends: abortion bans, restrictions on medication abortion, restrictions on insurance coverage for abortion, and targeted regulation of abortion providers ("TRAP")

Denial of abortion in legal settings.

BackgroundFactors such as poverty, stigma, lack of knowledge about the legal status of abortion, and geographical distance from a provider may prevent women from accessing safe abortion services, even where abortion is legal. Data on the consequences of abortion denial outside of the US, however, are scarce.MethodsIn this article we present data from studies among women seeking legal abortion services in four countries (Colombia, Nepal, South Africa and Tunisia) to assess sociodemographic characteristics of legal abortion seekers, as well as the frequency and reasons that women are denied abortion care.ResultsThe proportion of women denied abortion services and the reasons for which they were denied varied widely by country. In Colombia, 2% of women surveyed did not receive the abortions they were seeking; in South Africa, 45% of women did not receive abortions on the day they were seeking abortion services. In both Tunisia and Nepal, 26% of women were denied their wanted abortions.ConclusionsThe denial of legal abortion services may have serious consequences for women's health and wellbeing. Additional evidence on the risk factors for presenting later in pregnancy, predictors of seeking unsafe illegal abortion, and the health consequences of illegal abortion and childbirth after an unwanted pregnancy is needed. Such data would assist the development of programmes and policies aimed at increasing access to and utilisation of safe abortion services where abortion is legal, and harm reduction models for women who are unable to access legal abortion services

'This Is Real Misery': Experiences of Women Denied Legal Abortion in Tunisia.

Barriers to accessing legal abortion services in Tunisia are increasing, despite a liberal abortion law, and women are often denied wanted legal abortion services. In this paper, we seek to explore the reasons for abortion denial and whether these reasons had a legal or medical basis. We also identify barriers women faced in accessing abortion and make recommendations for improved access to quality abortion care. We recruited women immediately after they had been turned away from legal abortion services at two facilities in Tunis, Tunisia. Thirteen women consented to participate in qualitative interviews two months after they were turned away from the facility. Women were denied abortion care on the day they were recruited due to three main reasons: gestational age, health conditions, and logistical barriers. Nine women ultimately terminated their pregnancies at another facility, and four women carried to term. None of the women attempted illegal abortion services or self-induction. Further research is needed in order to assess abortion denial from the perspective of providers and medical staff

Estimating the proportion of Medicaid-eligible pregnant women in Louisiana who do not get abortions when Medicaid does not cover abortion.

BackgroundTo estimate the proportion of pregnant women in Louisiana who do not obtain abortions because Medicaid does not cover abortion.MethodsTwo hundred sixty nine women presenting at first prenatal visits in Southern Louisiana, 2015-2017, completed self-administered iPad surveys and structured interviews. Women reporting having considered abortion were asked whether Medicaid not paying for abortion was a reason they had not had an abortion. Using study data and published estimates of births, abortions, and Medicaid-covered births in Louisiana, we projected the proportion of Medicaid births that would instead be abortions if Medicaid covered abortion in Louisiana.Results28% considered abortion. Among women with Medicaid, 7.2% [95% CI 4.1-12.3] reported Medicaid not paying as a reason they did not have an abortion. Existing estimates suggest 10% of Louisiana pregnancies end in abortion. If Medicaid covered abortion, this would increase to 14% [95% CI 12, 16]. 29% [95% CI 19, 41] of Medicaid eligible pregnant women who would have an abortion with Medicaid coverage, instead give birth.ConclusionsFor a substantial proportion of pregnant women in Louisiana, the lack of Medicaid funding remains an insurmountable barrier to obtaining an abortion. Forty years after the Hyde Amendment was passed, lack of Medicaid funding for abortion continues to have substantial impacts on women's ability to obtain abortions

Safe abortion – Still a neglected scenario: A study of septic abortions in a tertiary hospital of Rural India

Background and Aims: In spite abortion has been legalized in India over three decades, unsafe abortion continues to be a significant contributor of maternal mortality and morbidity. The aim of the present study is to assess the magnitude of septic abortion in a tertiary care hospital over a period of three years with a special emphasis on maternal mortality and morbidity and various surgical complications. Settings and Design: Retrospective study of patients who were admitted with unsafe abortions over a three year period from 2005 to 2008 in a tertiary teaching Hospital of Rural India. Materials and Methods: Hospital records of the patients who were admitted with unsafe abortion in three years (2005-2008) were reviewed to evaluate the demographic and clinical profile in relation to age, parity, marital status, indication of abortion , the methods of abortion ,qualification of abortion provider complications and maternal mortality. Results: Unsafe abortion constitutes 11.6% ( n=132) of total abortion cases admitted over 3 years. Majority of women (70.45%) were in their thirties, married (89%).Sixty percent wanted abortion for birth spacing. Abortion methods included various primitive methods (30%) but majority by dilatation and evacuation. About 60% of abortionists were unqualified. Majority of women admitted with serious complications like peritonitis (70%), visceral injuries (60%), hemorrhagic and septic shock, renal failure (17.4%), and life threatening conditions like DIC, hepatic failure and encephalopathy. A total of 231 women died of unsafe abortion making it 12.55% of total maternal mortality in our institution. Out of 73 women requiring laparotomy, 22% were done within 24 hours of admission and majority (49%) were performed beyond 24-48 hours. Interestingly no women died when early aggressive surgery was done. Conclusion: The present study confirms that unsafe abortion is a great neglected health care problem leading to a considerable loss of maternal lives. Education and accessibility of contra caption, readily available, quality abortion services by trained abortion providers remain the key to limit mortality and morbidity arising from unsafe abortion

Comprehensive abortion care: evidence of improvements in hospital-level indicators in Tigray, Ethiopia.

ObjectiveApproximately 18% of maternal deaths in East Africa is attributable to unsafe abortion. Availability of comprehensive abortion care (CAC) services at all levels of the healthcare system, including medical abortion, has the potential to increase access to safe abortion thereby reducing the burden of unsafe abortion. This study sought to assess trends in abortion-related morbidity indicators in referral hospitals.DesignResearchers conducted a secondary data analysis on retrospectively collected data.MethodsData analysed were collected from four hospitals in the Tigray region of Ethiopia that took part in a CAC pilot project. Providers were trained in mid-2009 to provide abortion services using all available technologies. Data records from hospitals were collected in 2012 for the years 2006 through 2012; 2006/2007 data were too sparse to include in the analyses.ResultsTrends in abortion-related services show a significant decrease in treatment of incomplete abortion, inverting the relationship between safe terminations and treatment of incompletes as a percentage of total abortions. Medication abortion was nearly non-existent in 2008, but increased steadily, representing 80% of total procedures in 2012. The inclusion of medication abortion and availability of CAC also contributed to a decline in inpatient procedures and prevalence of complications.ConclusionsThe trends observed in the data demonstrate how increased availability of CAC services at all levels of the healthcare system, among other factors, can contribute to reductions in the burden of unsafe abortion at referral hospitals

Genetic Selective Abortion: Still a Matter of Choice

Jeremy Williams has argued that if we are committed to a liberal pro-choice stance with regard to selective abortion for disability, we will be unable to justify the prohibition of sex selective abortion. Here, I apply his reasoning to selective abortion based on other traits pregnant women may decide are undesirable. These include susceptibility to disease, level of intelligence, physical appearance, sexual orientation, religious belief and criminality—in fact any traits attributable to some degree to a genetic component. Firstly, I review Williams’ argument, which claims that if a woman is granted the right to abort based on fetal impairment, then by parity of reasoning she should also be granted the right to choose sex selective abortion. I show that these same considerations that entail the permissibility of sex selective abortion are also applicable to genetic selection abortion. I then examine the objections to sex selective abortion that Williams considers and rejects, and show that they also lack force against genetic selection abortion. Finally, I consider some additional objections that might be raised, and conclude that a liberal pro-choice stance on selective abortion for disability entails the permissibility of selective abortion for most genetic traits

Attitudes, Intentions, and Ethical Stance of Advanced Practice Nursing Students toward Abortion Provision: Part One B Quantitative Findings

The availability of pre-implantation abortion pills has increased the probability that advanced practice nurses (i.e., nurse practitioners and certified nurse midwives) will be instrumental in providing abortion services in the United States. The purpose of this pilot study was to determine the attitudes, intentions, and ethical stance of advanced practice nursing students towards the provision of abortion services. The study was a descriptive cross-sectional survey of 53 advanced practice nursing students at a private Midwestern Catholic university. A multi-item abortion attitude survey was administered to students in three required courses. The survey included a section on ethical principles and open-ended questions on abortion attitudes. The nursing students were either in a woman-related specialty, pediatrics, or in general adult nursing; most were between the ages of 24-29 (60.5%); and most (66.0%) were Roman Catholic. A majority (61.5%) did not feel that abortion should be available under any circumstance. However, 54% felt that advanced practice nurses should be able to provide abortion services. Few (7.7%) plan on incorporating abortion into their practices but 74.4% would refer for abortion services. The most frequent reasons for not willing to provide abortion were: (1) out of scope of practice (53.8%), (2) religious beliefs (59.0%), and (3) personal values (64.1%). The respondents for most part indicated either Sacred Life (43.6%) or Human Life/Utilitarian (48.7%) as their ethical stance. The Human Life/Utilitarian students had a significantly higher willingness to provide abortion services than Sacred Life students (p \u3c 0.05). Although the majority of advanced practice nursing students did not intend to provide abortion services, most were open to referring for abortion services and saw abortion as a personal right