Do 72-Hour Waiting Periods and Two-Visit Requirements for Abortion Affect Women's Certainty? A Prospective Cohort Study

PurposeThis paper examines how Utah's two-visit requirement and 72-hour waiting period influence women's certainty about their decision to have an abortion.ProceduresThis study uses data from a prospective cohort study of 500 women who presented at an abortion information visit at four Utah family planning facilities. At the information visit, participants completed a baseline survey; 3 weeks later, they completed telephone interviews that assessed their pregnancy outcome, change in certainty, and factors affecting changes in certainty.Main findingsOverall, 63% reported no change in certainty owing to the information visit and 74% reported no change in certainty owing to the waiting period. Changes in certainty were primarily in the direction of increased certainty, with more women reporting an increase (29%) than a decrease (8%) in certainty owing to the visit and more women reporting an increase (17%) than a decrease (8%) owing to waiting. Changes in certainty in either direction were concentrated among the minority (8%) who were conflicted about their decision at baseline. Learning about the procedure, meeting staff, and discovering that the facility was a safe medical environment were main contributors to increased certainty.ConclusionMost women were certain of their decision to have an abortion when they presented for their abortion information visit and their certainty remained unchanged despite the information visit and 72-hour waiting period. Changes in certainty were largely concentrated in the minority of women who expressed uncertainty about their decision before the beginning of the information visit. Thus, individualized counseling for the minority who are conflicted when they first present for care seems more appropriate than universal requirements

Mothers, Morals, and Medicine: Navigating Stigma and Identity in the Abortion Experience

Abortion in the United States is generally considered a highly contested moral andpolitical issue. Two competing activist frameworks tend to dominate the public conversation around abortion. Yet the experience of having an abortion is socially complex, often shaped by inconsistent cultural schemas related to motherhood, medicine, life, and death. Little empirical research examines how people talk about the morality of their own abortion experiences. In this dissertation I examine how individuals who have abortions construct moral identities in the face of persistent gendered stigma. The dissertation is in the format of three research papers. In the first paper, I analyze 156 personal narratives from an abortion storytelling website. I identify four discursive frameworks used to confront the problem of abortion as a morally controversial act. In the second paper, I examine eighteen in-depth interviews with cisgender women who obtained abortions after receiving a diagnosis for a serious fetal condition. I examine how participants maintained moral worth and constructed symbolic boundaries between themselves and those who have abortions for reasons other than fetal health. In the last paper, I question why, despite an unambivalent embrace of motherhood ideals and severe fetal diagnoses, this group of women experienced abortion stigma. I identify a need for a theoretical reorientation toward defining abortion stigma as a multi-level social process embedded in existing structures of power and inequality. The findings of this research contribute to an evolving discussion of how the perspectives of people who have had abortions fit into abortion rights discourses and the broader public sphere

Do 72-Hour Waiting Periods and Two-Visit Requirements for Abortion Affect Women's Certainty? A Prospective Cohort Study.

PurposeThis paper examines how Utah's two-visit requirement and 72-hour waiting period influence women's certainty about their decision to have an abortion.ProceduresThis study uses data from a prospective cohort study of 500 women who presented at an abortion information visit at four Utah family planning facilities. At the information visit, participants completed a baseline survey; 3 weeks later, they completed telephone interviews that assessed their pregnancy outcome, change in certainty, and factors affecting changes in certainty.Main findingsOverall, 63% reported no change in certainty owing to the information visit and 74% reported no change in certainty owing to the waiting period. Changes in certainty were primarily in the direction of increased certainty, with more women reporting an increase (29%) than a decrease (8%) in certainty owing to the visit and more women reporting an increase (17%) than a decrease (8%) owing to waiting. Changes in certainty in either direction were concentrated among the minority (8%) who were conflicted about their decision at baseline. Learning about the procedure, meeting staff, and discovering that the facility was a safe medical environment were main contributors to increased certainty.ConclusionMost women were certain of their decision to have an abortion when they presented for their abortion information visit and their certainty remained unchanged despite the information visit and 72-hour waiting period. Changes in certainty were largely concentrated in the minority of women who expressed uncertainty about their decision before the beginning of the information visit. Thus, individualized counseling for the minority who are conflicted when they first present for care seems more appropriate than universal requirements

Educational barriers, social isolation, and stable romantic relationships among pregnant immigrant Latina teens.

Latina teen birth rates, particularly those of immigrant Latinas, surpass those of any major racial/ ethnic group. Little is known about how immigration experiences influence early childbearing. Fourteen pregnant Latina immigrant teens were interviewed regarding their feelings about pregnancy and birth control, educational and vocational expectations, and their partners' influences. Common themes included feelings of isolation, barriers to education and future opportunities, and a heavy reliance on partners as a stable source of emotional and financial support, all of which appeared to influence teens' desire for pregnancy. Findings suggest the need to help immigrant youth overcome barriers to education and work and to offer them culturally and linguistically appropriate clinical care including birth control information and services, preconception and prenatal care, and assistance navigating the system

Educational barriers, social isolation, and stable romantic relationships among pregnant immigrant Latina teens.

Latina teen birth rates, particularly those of immigrant Latinas, surpass those of any major racial/ ethnic group. Little is known about how immigration experiences influence early childbearing. Fourteen pregnant Latina immigrant teens were interviewed regarding their feelings about pregnancy and birth control, educational and vocational expectations, and their partners' influences. Common themes included feelings of isolation, barriers to education and future opportunities, and a heavy reliance on partners as a stable source of emotional and financial support, all of which appeared to influence teens' desire for pregnancy. Findings suggest the need to help immigrant youth overcome barriers to education and work and to offer them culturally and linguistically appropriate clinical care including birth control information and services, preconception and prenatal care, and assistance navigating the system

Limited socioeconomic opportunities and Latina teen childbearing: a qualitative study of family and structural factors affecting future expectations.

The decrease in adolescent birth rates in the United States has been slower among Latinas than among other ethnic/racial groups. Limited research has explored how socioeconomic opportunities influence childbearing among Latina adolescents. We conducted in-depth interviews with 65 pregnant foreign- and US-born Latina women (31 adolescents; 34 adults) in two California counties. We assessed perceived socioeconomic opportunities and examined how family, immigration and acculturation affected the relationships between socioeconomic opportunities and adolescent childbearing. Compared with women who delayed childbearing into adulthood, pregnant adolescents described having few resources for educational and career development and experiencing numerous socioeconomic and social barriers to achieving their goals. Socioeconomic instability and policies limiting access to education influenced childbearing for immigrant adolescents. In contrast, family disintegration tied to poverty figured prominently in US-born adolescents childbearing. Limited socioeconomic opportunities may play a large role in persistently high pregnancy rates among Latina adolescents

Limited socioeconomic opportunities and Latina teen childbearing: a qualitative study of family and structural factors affecting future expectations.

The decrease in adolescent birth rates in the United States has been slower among Latinas than among other ethnic/racial groups. Limited research has explored how socioeconomic opportunities influence childbearing among Latina adolescents. We conducted in-depth interviews with 65 pregnant foreign- and US-born Latina women (31 adolescents; 34 adults) in two California counties. We assessed perceived socioeconomic opportunities and examined how family, immigration and acculturation affected the relationships between socioeconomic opportunities and adolescent childbearing. Compared with women who delayed childbearing into adulthood, pregnant adolescents described having few resources for educational and career development and experiencing numerous socioeconomic and social barriers to achieving their goals. Socioeconomic instability and policies limiting access to education influenced childbearing for immigrant adolescents. In contrast, family disintegration tied to poverty figured prominently in US-born adolescents' childbearing. Limited socioeconomic opportunities may play a large role in persistently high pregnancy rates among Latina adolescents

Comparison of Outcomes before and after Ohio's Law Mandating Use of the FDA-Approved Protocol for Medication Abortion: A Retrospective Cohort Study

<div><p>Background</p><p>In February 2011, an Ohio law took effect mandating use of the United States Food and Drug Administration (FDA)-approved protocol for mifepristone, which is used with misoprostol for medication abortion. Other state legislatures have passed or enacted similar laws requiring use of the FDA-approved protocol for medication abortion. The objective of this study is to examine the association of this legal change with medication abortion outcomes and utilization.</p><p>Methods and Findings</p><p>We used a retrospective cohort design, comparing outcomes of medication abortion patients in the prelaw period to those in the postlaw period. Sociodemographic and clinical chart data were abstracted from all medication abortion patients from 1 y prior to the law’s implementation (January 2010–January 2011) to 3 y post implementation (February 2011–October 2014) at four abortion-providing health care facilities in Ohio. Outcome data were analyzed for all women undergoing abortion at ≤49 d gestation during the study period. The main outcomes were as follows: need for additional intervention following medication abortion (such as aspiration, repeat misoprostol, and blood transfusion), frequency of continuing pregnancy, reports of side effects, and the proportion of abortions that were medication abortions (versus other abortion procedures). Among the 2,783 medication abortions ≤49 d gestation, 4.9% (95% CI: 3.7%–6.2%) in the prelaw and 14.3% (95% CI: 12.6%–16.0%) in the postlaw period required one or more additional interventions. Women obtaining a medication abortion in the postlaw period had three times the odds of requiring an additional intervention as women in the prelaw period (adjusted odds ratio [AOR] = 3.11, 95% CI: 2.27–4.27). In a mixed effects multivariable model that uses facility-months as the unit of analysis to account for lack of independence by site, we found that the law change was associated with a 9.4% (95% CI: 4.0%–18.4%) absolute increase in the rate of requiring an additional intervention. The most common subsequent intervention in both periods was an additional misoprostol dose and was most commonly administered to treat incomplete abortion. The percentage of women requiring two or more follow-up visits increased from 4.2% (95% CI: 3.0%–5.3%) in the prelaw period to 6.2% (95% CI: 5.5%–8.0%) in the postlaw period (<i>p</i> = 0.003). Continuing pregnancy was rare (0.3%). Overall, 12.6% of women reported at least one side effect during their medication abortion: 8.4% (95% CI: 6.8%–10.0%) in the prelaw period and 15.6% (95% CI: 13.8%–17.3%) in the postlaw period (<i>p</i> < 0.001). Medication abortions fell from 22% (95% CI: 20.8%–22.3%) of all abortions the year before the law went into effect (2010) to 5% (95% CI: 4.8%–5.6%) 3 y after (2014) (<i>p</i> < 0.001). The average patient charge increased from US$426 in 2010 to US$551 in 2014, representing a 16% increase after adjusting for inflation in medical prices. The primary limitation to the study is that it was a pre/post-observational study with no control group that was not exposed to the law.</p><p>Conclusions</p><p>Ohio law required use of a medication abortion protocol that is associated with a greater need for additional intervention, more visits, more side effects, and higher costs for women relative to the evidence-based protocol. There is no evidence that the change in law led to improved abortion outcomes. Indeed, our findings suggest the opposite. In March 2016, the FDA-protocol was updated, so Ohio providers may now legally provide current evidence-based protocols. However, this law is still in place and bans physicians from using mifepristone based on any new developments in clinical research as best practices continue to be updated.</p></div