Complex situations: Economic insecurity, mental health, and substance use among pregnant women who consider - but do not have - abortions.

We examine characteristics and experiences of women who considered, but did not have, an abortion for this pregnancy. Participants were recruited at prenatal care clinics in Louisiana and Maryland for a mixed-methods study (N = 589). On self-administered surveys and structured interviews, participants were asked if they had considered abortion for this pregnancy and, if so, reasons they did not obtain one. A subset (n = 83), including participants who considered abortion for this pregnancy, completed in-depth phone interviews. Multivariable logistic regression analyses examined characteristics associated with having considered abortion and experiencing a policy-related barrier to having an abortion; analyses focused on economic insecurity and of mental health/substance use as main predictors of interest. Louisiana interviews (n = 43) were analyzed using modified grounded theory to understand concrete experiences of policy-related factors. In regression analyses, women who reported greater economic insecurity (aOR 1.21 [95% CI 1.17, 1.26]) and more mental health diagnoses/substance use (aOR 1.29 [1.16, 1.45] had higher odds of having considered abortion. Those who reported greater economic insecurity (aOR 1.50 [1.09, 2.08]) and more mental health diagnoses/substance use (aOR 1.45 [95% CI 1.03, 2.05] had higher odds of reporting policy-related barriers. Interviewees who considered abortion and were subject to multiple restrictions on abortion identified material and instrumental impacts of policies that, collectively, contributed to them not having an abortion. Many described simultaneously navigating economic insecurity, mental health disorders, substance use, and interpersonal opposition to abortion from family and the man involved in the pregnancy. Current restrictive abortion policies appear to have more of an impact on women who report greater economic insecurity and more mental health diagnoses/substance use. These policies work in concert with each other, with people's individual complex situations-including economic insecurity, mental health, and substance use-and with anti-abortion attitudes of other people to make abortion care impossible for some pregnant women to access

Emotions and decision rightness over five years following an abortion: An examination of decision difficulty and abortion stigma

Available online 13 January 2020, Article 112704Uno de los estudios más grandes sobre las emociones de las mujeres después de un aborto encontró que la mayoría se siente aliviada y no se arrepiente de su elección, incluso si pensaron mucho para tomar la decisión o si se preocuparon por el estigma. Los investigadores descubrieron que a los cinco años de haber tenido un aborto, solo el 6% expresó principalmente emociones negativas. La abrumadora mayoría de las mujeres encuestadas, el 84%, tenían emociones positivas o ninguna con respecto a su decisión de abortar, incluso si no se habían sentido así cuando estaban tomando la decisión de abortar.Poco más de la mitad de las mujeres en esta encuesta dijeron que la decisión de interrumpir el embarazo fue muy difícil y el 27% lo calificó como “algo difícil”. Alrededor del 46% dijo que no fue una decisión difícil en absoluto. Casi el 70% dijo sentir que serían estigmatizadas si las personas supieran que tuvieron un aborto. Las mujeres que dijeron que fue difícil tomar la decisión o se sintieron estigmatizadas por ella tenían más probabilidades de reportar culpa, ira o tristeza inmediatamente después del aborto, pero con el tiempo, estos sentimientos disminuyeron drásticamente, a veces incluso un año después del aborto.La principal emoción que todos los grupos de mujeres en el estudio dijeron que sintieron al final de la encuesta fue el alivio. El alivio era una emoción utilizada para describir cómo se sentían cada vez que se les preguntaba al respecto.www.elsevier.com/locate/socscime

Access to and experience of later abortion: accounts from women in Scotland

Context: Except in the presence of significant medical indications, the legal limit for abortion in Great Britain is 24 weeks’ gestation. Nevertheless, abortion for nonmedical reasons is not usually provided in Scotland after 18–20 weeks, meaning women have to travel to England for the procedure. Methods: In-depth interviews were conducted with 23 women presenting for "later" abortions (i.e., at 16 or more weeks’ gestation) in Scotland. Participants were women who sought an abortion at a participating National Health Service clinic between January and July 2013. Interviews addressed reasons for and consequences of later presentation, as well as women's experiences of abortion. Thematic analysis attended to emerging issues and employed the conceptual tool of candidacy. Results: Delayed recognition of pregnancy, changed life circumstances and conflicting candidacies for motherhood and having an abortion were common reasons for women's presentation for later abortion. Women perceived that the resources required to travel to England for a later abortion were potential barriers to access, and felt that such travel was distressing and stigmatizing. Participants who continued their pregnancy did so after learning they were at a later gestational age than expected or after receiving assurances of support from partners, friends or family. Conclusions: Reasons for seeking later abortion are complex and varied among women in Scotland, and suggest that reducing barriers to access and improving local provision of such abortions are a necessity. The candidacy framework allows for a fuller understanding of the difficulties involved in obtaining abortions

Law and Family Formation Among LGBQ-Parent Families

This article addresses how the law affects family formation among families with lesbian, gay, bisexual, and queer (LGBQ) parents in the United States. Our discussion draws on a socio-legal approach to law that focuses not only on the law on the books (what we refer to as “legal barriers”) but also on issues like how the law is practiced, how people experience the law in everyday life, and how the law serves as an interpretive framework through which people understand themselves and their families (what we refer to as “social barriers”). In our review, we highlight how attorneys can play a role in valuing and advancing rights for LGBQ-parent families and LGBTQ prospective parents

Measuring decisional certainty among women seeking abortion

ObjectiveEvaluating decisional certainty is an important component of medical care, including preabortion care. However, minimal research has examined how to measure certainty with reliability and validity among women seeking abortion. We examine whether the Decisional Conflict Scale (DCS), a measure widely used in other health specialties and considered the gold standard for measuring this construct, and the Taft-Baker Scale (TBS), a measure developed by abortion counselors, are valid and reliable for use with women seeking abortion and predict the decision to continue the pregnancy.MethodsEligible women at four family planning facilities in Utah completed baseline demographic surveys and scales before their abortion information visit and follow-up interviews 3 weeks later. For each scale, we calculated mean scores and explored factors associated with high uncertainty. We evaluated internal reliability using Cronbach's alpha and assessed predictive validity by examining whether higher scale scores, indicative of decisional uncertainty or conflict, were associated with still being pregnant at follow-up.ResultsFive hundred women completed baseline surveys; two-thirds (63%) completed follow-up, at which time 11% were still pregnant. Mean scores on the DCS (15.5/100) and TBS (12.4/100) indicated low uncertainty, with acceptable reliability (α=.93 and .72, respectively). Higher scores on each scale were significantly and positively associated with still being pregnant at follow-up in both unadjusted and adjusted analyses.ConclusionThe DCS and TBS demonstrate acceptable reliability and validity among women seeking abortion care. Comparing scores on the DCS in this population to other studies of decision making suggests that the level of uncertainty in abortion decision making is comparable to or lower than other health decisions.ImplicationsThe high levels of decisional certainty found in this study challenge the narrative that abortion decision making is exceptional compared to other healthcare decisions and requires additional protection such as laws mandating waiting periods, counseling and ultrasound viewing

Understanding why women seek abortions in the US

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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