The Presence and Consequences of Abortion Aversion in Scientific Research Related to Alcohol Use during Pregnancy.

Recent research has found that most U.S. state policies related to alcohol use during pregnancy adversely impact health. Other studies indicate that state policymaking around substance use in pregnancy-especially in the U.S.-appears to be influenced by an anti-abortion agenda rather than by public health motivations. This commentary explores the ways that scientists' aversion to abortion appear to influence science and thus policymaking around alcohol and pregnancy. The three main ways abortion aversion shows up in the literature related to alcohol use during pregnancy include: (1) a shift from the recommendation of abortion for "severely chronic alcoholic women" to the non-acknowledgment of abortion as an outcome of an alcohol-exposed pregnancy; (2) the concern that recommendations of abstinence from alcohol use during pregnancy lead to terminations of otherwise wanted pregnancies; and (3) the presumption of abortion as a negative pregnancy outcome. Thus, abortion aversion appears to influence the science related to alcohol use during pregnancy, and thus policymaking-to the detriment of developing and adopting policies that reduce the harms from alcohol during pregnancy

The development of facility standards for common outpatient procedures and implications for the context of abortion.

BackgroundIn recent years, an increasing number of states have enacted laws that impose specific requirements for facilities in which abortions are performed. In this study, we sought to understand the processes used to develop facility standards in the context of other, less politically charged areas of health care and consider implications for the context of abortion.MethodsWe conducted key informant interviews with 20 clinicians and accreditation professionals involved in facility standards development for common outpatient procedures (endoscopy, gynecology, oral surgery, plastic surgery). We examined the motivations for and processes used in facility standards development, use of scientific evidence in standards development, and decision-making in the absence of evidence. Interview data were thematically coded and analyzed using an iterative approach.ResultsIn contrast to U.S. state laws that target abortion facilities, standards for other outpatient procedures are commonly set by committees of clinicians organized by professional associations or accreditation organizations. These committees seek to establish standards that ensure patient safety without placing unnecessary burden on clinicians in practice. They aim to create evidence-based standards but can be hampered by lack of relevant research. In the absence of research evidence, committees rely on their clinical expertise and sense of best practices in decision-making. According to respondents, considerations of potential harm (e.g., deeper levels of sedation, invasiveness), rather than the specific procedure, should prompt additional requirements.ConclusionsIf facility standards in the context of abortion were developed through processes similar to other outpatient procedures, 1) professionals who perform the procedure would be involved in standards development and 2) in the absence of clear research evidence, the expertise of clinicians, and the guidelines and standards of other organizations, are used to describe a best practice standard of care

Costs associated with policies regarding alcohol use during pregnancy: Results from 1972-2015 Vital Statistics.

Background and objectiveAs of 2016, 43 US states have policies regarding alcohol use during pregnancy. A recent study found that out of eight state-level alcohol/pregnancy policies, six are significantly associated with poorer birth outcomes, and two are not associated with any outcomes. Here we estimate the excess numbers of low birthweight (LBW) and preterm births (PTB) related to these policies and their associated additional costs in the first year of life.MethodsCost study using birth certificate data for 155,446,714 singleton live births in the United States between 1972-2015. Exposures were state- and month/year-specific indicators of having each of eight alcohol/pregnancy policies in place. Outcomes were excess numbers of LBW and PTB and associated costs in the first year of life. Fixed effects regressions with state-specific time trends were used for statistical analyses in 2018.ResultsIn 2015, policies mandating warning signs were associated with an excess of 7,375 LBW; policies defining alcohol use during pregnancy as child abuse/neglect were associated with an excess of 12,372 PTB; these excess adverse outcomes are associated with additional costs of $151,928,002 and$582,698,853 in the first year of life, respectively.ConclusionsMultiple state-level alcohol pregnancy policies lead to increased prevalence of LBW and PTB, which cost hundreds of millions of dollars annually. Policymakers should consider adverse public health impacts of alcohol/pregnancy policies before expanding extant policies to new substances or adopting existing policies in new states

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

Options for managing human threats to high seas biodiversity

Areas beyond national jurisdiction (ABNJ) constitute 61% of the world's oceans and are collectively managed by countries under the United Nations Convention on the Law of the Sea (UNCLOS). Growing concern regarding the deteriorating state of the oceans and ineffective management of ABNJ has resulted in negotiations to develop an international legally binding instrument (ILBI) for the conservation and sustainable use of biodiversity beyond national jurisdiction under UNCLOS. To inform these negotiations, we identified existing and emerging human activities and influences that affect ABNJ and evaluated management options available to mitigate the most pervasive, with highest potential for impact and probability of emergence. The highest-ranking activities and influences that affect ABNJ were fishing/hunting, maritime shipping, climate change and its associated effects, land-based pollution and mineral exploitation. Management options are diverse and available through a variety of actors, although their actions are not always effective. Area-based management tools (ABMTs), including marine protected areas (MPAs), were the only consistently effective option to mitigate impacts across high-ranked activities and influences. However, addressing land-based pollution will require national action to prevent this at its source, and MPAs offer only a partial solution for climate change. A new ABNJ ILBI could help unify management options and actors to conserve marine biodiversity and ensure sustainable use. Incorporating a mechanism to establish effective ABMTs into the ILBI will help deliver multiple objectives based on the ecosystem approach

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

Perceived stress and emotional social support among women who are denied or receive abortions in the United States: a prospective cohort study.

BackgroundExamining women's stress and social support following denial and receipt of abortion furthers understanding of the effects of unwanted childbearing and abortion on women's well-being. This study investigated perceived stress and emotional social support over time among women who were denied wanted abortions and who received abortions, and compared outcomes between the groups.MethodsThe Turnaway Study is a prospective cohort study of women who sought abortions at 30 abortion facilities across the United States, and follows women via semiannual phone interviews for five years. Participants include 956 English or Spanish speaking women aged 15 and over who sought abortions between 2008 and 2010 and whose gestation in pregnancy fit one of three groups: women who presented up to three weeks beyond a facility's gestational age limit and were denied an abortion; women presenting within two weeks below the limit who received an abortion; and women who received a first trimester abortion. The outcomes were modified versions of the Perceived Stress Scale and the Multidimensional Scale of Perceived Social Support. Longitudinal mixed effects models were used to assess differences in outcomes between study groups over 30 months.ResultsWomen denied abortions initially had higher perceived stress than women receiving abortions near gestational age limits (1.0 unit difference on 0-16 scale, P = 0.003). Women receiving first-trimester abortions initially had lower perceived stress than women receiving abortions near gestational age limits (0.6 difference, P = 0.045). By six months, all groups' levels of perceived stress were similar, and levels remained similar through 30 months. Emotional social support scores did not differ among women receiving abortions near gestational limits versus women denied abortions or women having first trimester abortions initially or over time.ConclusionsSoon after being denied abortions, women experienced higher perceived stress than women who received abortions. The study found no longer-term differences in perceived stress or emotional social support between women who received versus were denied abortions

The effects of 118 years of industrial fishing on UK bottom trawl fisheries

This is the final version of the article. Available from Springer Nature via the DOI in this record.In 2009, the European Commission estimated that 88% of monitored marine fish stocks were overfished, on the basis of data that go back 20 to 40 years and depending on the species investigated. However, commercial sea fishing goes back centuries, calling into question the validity of management conclusions drawn from recent data. We compiled statistics of annual demersal fish landings from bottom trawl catches landing in England and Wales dating back to 1889, using previously neglected UK Government data. We then corrected the figures for increases in fishing power over time and a recent shift in the proportion of fish landed abroad to estimate the change in landings per unit of fishing power (LPUP), a measure of the commercial productivity of fisheries. LPUP reduced by 94% - 17-fold - over the past 118 years. This implies an extraordinary decline in the availability of bottom-living fish and a profound reorganization of seabed ecosystems since the nineteenth century industrialization of fishing.R.H.T. was supported by Natural England and a Mia J. Tegner Memorial Research Grant. S.B. was supported by a Ray Lankester Investigatorship from the Marine Biological Association of the United Kingdom

The National COPD Audit – what you need to know

The secondary care work stream of the National COPD Audit Programme aims to improve care and outcomes for patients with exacerbation of chronic obstructive pulmonary disease (COPD) wherever and whenever they are admitted to hospital. To achieve this, prospective audit is combined with real-time feedback of data to individual units, together with support for quality improvement and high-level change levers. COPD exacerbations comprise a large proportion of the acute take. Only by working collaboratively across emergency, acute and general medicine, respiratory, geriatric and other teams can individual trusts deliver optimal care. This review provides background to the national COPD audit programme, relevant to all those caring for people with COPD exacerbations in secondary care

Gender Equality, Drinking Cultures and Second-Hand Harms from Alcohol in the 50 US States.

BackgroundGender inequality and cultures of binge drinking may increase the risk of second-hand harms from alcohol.MethodsUsing the 2014-2015 National Alcohol Survey and 2015 National Alcohol's Harm to Others Survey (N = 7792), we examine associations of state-level gender equality measures (contraceptive access, abortion rights, women's economic equality) and binge drinking cultures (rates of men's and women's binge drinking) with individual-level indicators of second-hand harms by drinking strangers and partners/spouses.ResultsIn main effects models, only male binge drinking was associated with greater odds of harms from drinking strangers. There were significant interactions of gender equality with male binge drinking: High male binge drinking rates were more strongly associated with stranger-perpetrated harms in states low on contraceptive access or abortion rights compared to states high on these measures. Conversely, male binge drinking was more strongly associated with spouse/partner-perpetrated second-hand harms in states with more economic equality, compared to states lower on this measure.ConclusionsDetrimental effects of high male binge drinking rates may be modified by gender equality. Targeted interventions may reduce alcohol-related harms experienced by women in states with high rates of male binge drinking. Restrictions in access to contraception and abortion may exacerbate harms due to men's drinking