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Background: Abortion stigma as reported globally has been inadequately documented empirically in Nigeria, Africa's most populous country with a restrictive abortion law and a high rate of unsafe abortions., Objective: The objectives of this study were to investigate the ways in which abortion stigma is experienced by Nigerian health professionals and how such experiences influence health professionals' practice of safe abortion and post-abortion care., Methods: The study utilized qualitative research consisting of in-depth interviews with 10 abortion providers. We elicited information with an open-ended interview guide that investigated the understanding of participants' experiences of abortion stigma in Nigeria. The data were analysed qualitatively and thematically using Atlas.ti., Results: The themes centred on perceptions and experiences of stigma among the providers interviewed. Participants' experiences of abortion stigma included the following: being treated differently to other health professionals; experiencing disapproval and disrespect; name-calling and societal judgement; tagging and profiling of clinics by anti-abortionists; and social isolation. Participants attributed stigma to cultural and religious beliefs, the restrictive national abortion law, and pointed to hypocrisy. Some reported effects of stigma on providers included a feeling of insecurity, social exclusion, secrecy, and insincerity in clinical practice, discouragement, and guilt feelings. Despite the negative impacts, many respondents reported a sense of satisfaction stemming from their views that they were saving lives., Conclusion: Systematic efforts to address these adverse factors could reduce the level of stigma experienced by providers, with a potential follow-through effect of improving women's access to safe abortion care in Nigeria.

Purpose: The aim of this retrospective cohort study was to investigate the effects of hysteroscopic uterine septum resection on the clinical pregnancy rate (CPR), live birth rate (LBR) and miscarriage rate., Materials and Method(s): Hospital records of consecutive patients who underwent hysteroscopic uterine septum resection between February 2021 and December 2022 were reviewed. They were telephoned and interviewed about their reproductive performance after surgery, and pregnancy outcomes, if achieved., Results and Conclusions: Sixty-nine eligible patients were enrolled. Forty-one (59.4%) of these patients were referred to our clinic for otherwise unexplained infertility of at least 1 year and 28 (40.6%) for pregnancy loss. During the follow-up period, 32 patients conceived. The overall CPR was 46.4%, the LBR per woman was 36.2%, the LBR per pregnancy was 78.1% and the miscarriage rate was 12.5%. The LBRs per pregnancy were 83.3% and 71.4% in the infertility and miscarriage subgroups, respectively. The miscarriage rates per pregnancy were 0% and 28.6% in the infertility and miscarriage subgroups, respectively. Three of 6 patients whose uterine septum was incomplete but prominent became pregnant (CPR: 50.0%), and all pregnancies resulted in live birth (LBR per pregnancy:100%, LBR per woman:50%). Two patients with complete uterine septum didn't achieve pregnancy. Hysteroscopic uterine septum resection may improve the CPR, LBR and miscarriage rates in subfertile population with and without previous pregnancy loss.

Abortion remains one of the most prevalent complications of pregnancy, contributing significantly to maternal mortality and presenting a substantial public health challenge. This study aimed to explore Rhazes' perspective on abortion and abortifacient medicinal plants he mentioned in Kitāb al-Ḥāwī fī al-Ṭibb. A detailed analysis of his seminal work, Kitāb al-Ḥāwī fī al-Ṭibb, was conducted. Relevant keywords such as abortion, stillbirth, fetus, drugs, and abortifacients were examined within Kitāb al-Ḥāwī fī al-Ṭibb. The analysis included Rhazes' viewpoints on abortion and the abortogenic drugs he mentioned, as well as their methods of administration, including oral dosage forms and vaginal formulations. Furthermore, relevant current literature was used to find the potential scientific rationales for Rhazes' insights. Our findings indicate that Rhazes contributed to obstetrics and gynecology as he discussed abortion, its prevention, and management in his book. Also, he identified various medicinal plants with potential abortogenic properties. Rhazes explained various administration methods, including rub, decoction, inhalation, suppository, enema, incense, and water bath. Even though his clinical practices and detailed observations provide a rich context for understanding the historical use of these agents, evidence-based medical practices need to be conducted to cleave potentially usable parts of Rhazes' perspectives and his approaches to the prevention and treatment of abortion. Moreover, there is a pressing need for well-designed randomized clinical trials to rigorously evaluate the potential efficacy and safety of the medical insights and the potential therapeutic herbal agents he described., Competing Interests: Declarations. Ethics approval: Not applicable as this is a historical narrative review and no animal or human subjects were studied. Consent to participate: Not applicable Consent for publication: Not applicable Competing interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

After a decline in the number of annual abortions from around 130,000 in the years 1996 to 2004 to around 100,000 since 2013/14, there was recently a certain increase again to 106,000 abortions in 2023. The decline from 2004 to 2013 was driven by a decrease in the number of women of childbearing age and a lower probability of having an abortion in the key age groups. When comparing the result structures over time, the constant development towards the use of Mifegyne® is noticeable. Regarding the duration of the terminated pregnancy, the proportion of early abortions has increased in recent years.There are differences in structures between the federal states. The probability of an abortion by age is relatively low in the south of the Republic but is above average in the city states and the new federal states. Further differences between the federal states can be identified with regard to the type of intervention used or the provider. The proportion of abortions carried out in another federal state also varies. The number of reporting healthcare providers can offer basic statistical information. Legal developments have been initiated, primarily for improved regionalization of data-while respecting statistical confidentiality., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: H. Pfaff gibt an, dass kein Interessenkonflikt besteht. Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien., (© 2024. The Author(s).)

The COVID-19 pandemic has had a drastic impact on healthcare systems. They had to react, adapt and innovate in order to build resilience, that is maintain healthcare access and health equity. For example, access to abortion services during the pandemic was increasingly facilitated through "Telehealth for Early Medical Abortion" (TEMA).This narrative review article compares Germany, France and Great Britain in terms of abortion numbers, methods and settings from 2018 to 2023. Changes in the availability of services and legislation during the pandemic are presented, and the differences between the countries, as well as various innovation factors, are discussed. We used national statistics and conducted a literature and online search (Rapid Review).In the three countries, there are differences in abortion rates, the share of medical abortions and the impact of the pandemic. In France and Great Britain, where medical abortion is the main method of abortion and where abortion care was more accessible before the pandemic than in Germany, a series of innovations were officially introduced to facilitate access during the pandemic. They included teleconsultations and the mailing of abortion medication. Most changes have been sustained since then, contributing to addressing historic and systemic health inequities in terms of access. In Germany, innovations during the pandemic have been crafted mainly by civil society organisations, offering for the first time teleabortion services.The COVID-19 pandemic provoked or accelerated innovation in terms of abortion care in France, Germany and Great Britain. The sustainability and scaling-up of those innovations remain fragile, especially in Germany, where the disruptive approach of civil society organisations has not yet found its way into mainstream healthcare services., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: C. Miani und J. Niemann geben an, dass kein Interessenkonflikt besteht. Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien., (© 2024. The Author(s).)

Purpose: Spousal authorisation for abortion (SA) is in direct conflict with the right to bodily autonomy. The World Health Organisation guideline on abortion specifically recommends that abortion should be available on request without third-party authorisation. The objectives of this study were to: a) determine which countries insist by law on SA, b) describe shared characteristics of these countries, c) assess the impact of such legislation on access to abortion and d) evaluate the chances of repeal of such laws., Methods: Interrogation of known databases on global abortion laws. Grouping of countries with SA laws according to their characteristics. A literature review of material on how mandatory SA relates to reproductive rights., Results: Fifteen countries were found to require SA. Nine of these countries have low freedom and democracy scores. Three South Eastern Asian countries, Japan, South Korea and Taiwan, have high freedom and democracy scores and no dominant religion. Broader studies on third-party authorisation for abortion show delayed access to abortion and emphasise the general principle that it is the healthcare seeker alone whose consent should be required for a health intervention. A qualitative study from Türkiye showed specifically how SA requirements could impair access to abortion., Conclusions: Twelve of the countries do not appear to have the necessary government or societal conditions necessary for abortion law modernisation in the near future. In contrast, Japan, South Korea and Taiwan are prime candidates for immediate liberalisation of their abortion laws.

Background: Missed abortion in the first trimester is characterized by the cessation of embryonic or fetal development while the cervix remains closed, often resulting in little to no bleeding. Ultrasound examinations typically reveal an empty gestational sac or an embryo/fetus that lacks cardiac activity. Misoprostol is the primary medication used to manage early pregnancy loss., Objectives: To compare the efficacy of misoprostol, orally and vaginally in management of first trimester missed abortion.", Study Selection: This systematic review included randomised control trials of patients with a confirmed diagnosis with first-trimester missed abortion, comparing oral and vaginal misoprostol for uterine evacuation success, induction-expulsion time, patient satisfaction and adverse events., Data Extraction and Analysis: Ten studies were included in this meta-analysis. All of them are RCTs with a number of patients 1,142 [578 in oral misoprostol group and 564 in vaginal misoprostol group]. Independent data extraction and quality assessment ensured unbiased results. We estimated risk ratios (RR) with 95% CIs using random-effects meta-analysis and evaluated quality of the included studies using Cochrane's Risk of Bias tool (RoB 2)., Results: We included 10 studies in our analysis and for our primary outcome, vaginal misoprostol had a higher success rate, [RR: 0.85, P = 0.004], shorter induction-expulsion interval [MD:4.95, P = 0.0001], and greater patient satisfaction compared to oral administration [RR:0.85, P = 0.01]. Secondary outcomes revealed significantly higher nausea and vomiting in the oral group, with no significant difference in headache, dizziness, diarrhea, fever, excessive bleeding, or discharge. Severe crampy pain was also significantly higher in the oral group., Conclusion: Our comprehensive review and meta-analysis indicate that the vaginal route of misoprostol is the most effective method for managing first-trimester missed abortions. This route achieves a significantly higher success rate and shorter induction- to-expulsion interval, along with greater patient satisfaction during follow-up sessions and fewer side effects., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Person-centered care is a fundamental principle of healthcare in Germany. The concept focuses on the preferences, needs, and values of individuals in the healthcare system. Studies show that unintentionally pregnant women seeking to terminate their pregnancy may encounter legal regulations, stigmatization, and ethical and moral concerns from healthcare providers. In Germany, the implementation of person-centered care in the care of unintentionally pregnant women has been scarcely researched. The goals of the CarePreg study (running from November 2020 to July 2024) were to evaluate person-centered care in psychosocial and medical care (1) from the perspective of healthcare providers as well as (2) from the perspective of women experiencing an unintended pregnancy and abortion, and (3) to derive recommendations for the current care situation. A mixed-methods approach was chosen for the study.This article presents the methodology of the CarePreg study and reports on the findings from two workshops involving 18 experts as part of the first study phase. Participants in the workshops were professionals from psychosocial and medical services for individuals with unintended pregnancies. They considered person-centered care highly relevant to abortion services, emphasizing dimensions such as "access to care," "personalized information," and "equal collaboration and involvement in decision-making." Barriers to person-centered care discussed included the stigmatization of abortion and those providing related services as well as the current legal framework., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: J. Zill hat für die Vorstellung der Studie bei der Hamburger Ärztekammer und einen Vortrag zur Studie im Rahmen von „update medizin Hamburger Fortbildungen“ des Labors Dr. Heidrich & Kollegen MVZ GmbH ein Honorar erhalten. A. Lindig gibt an, dass kein Interessenkonflikt besteht. Die Studie wurde im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Es wurden die Prinzipien guter wissenschaftlicher Praxis eingehalten und die Standards der Forschungsethik erfüllt. Die Studie wurde von der Lokalen Ethikkommission des Universitätsklinikums Hamburg-Eppendorf, Deutschland (LPEK-0260) genehmigt. Datenschutz- und Vertraulichkeitsanforderungen wurden erfüllt. Die Teilnahme an der Studie war freiwillig. Von allen Teilnehmer:innen liegt eine Einverständniserklärung vor., (© 2024. The Author(s).)

Objective: To compare the outcomes of open appendectomy (OA) and laparoscopic appendectomy (LA) for acute appendicitis during pregnancy by trimester., Methods: We conducted a nationwide retrospective cohort study using the Diagnosis Procedure Combination database in Japan. We identified pregnant women diagnosed with appendicitis who underwent OA or LA from 2010 to 2022. Pathological confirmation of appendicitis was not required for inclusion. The patients were categorized by the trimester of pregnancy. Outcomes were compared using multivariate analysis with generalized estimating equations., Results: A total of 1624 patients were included. In the first trimester, 64.2% patients underwent OA, whereas 35.8% patients underwent LA; in the second trimester, 59.1% patients had OA and 40.9% patients had LA; and in the third trimester, 72.8% patients had OA and 27.2% patients had LA. LA was associated with a higher rate of preterm labor, preterm delivery, or abortion in the second (odds ratio, 3.37; 95% confidence interval, 1.76-6.47; and p < 0.001) and third trimesters (odds ratio, 2.57; 95% confidence interval, 1.15-5.70; and p = 0.021) but not in the first trimester. The duration of surgery was longer across all trimesters in patients who underwent LA. Additionally, the postoperative hospital stay was shorter in patients who had LA than in those who had OA in the second trimester., Conclusions: In-hospital outcomes vary by trimester, and our results suggest that LA does not consistently lead to better outcomes than OA. Based on our findings, treatment options for appendicitis during pregnancy must be carefully selected., (© 2024 International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).)

Background: Abortion is one of the most common medical procedures worldwide. Despite this, access to abortion on demand remains restricted in many countries, including Poland. As a result, many women resort to undergoing the procedure without medical supervision, putting themselves at risk of serious health consequences such as drug poisoning, excessive bleeding, and hypovolemia. Unfortunately, some abortions also lead to severe infections., Objective: This study aims to qualitatively identify key themes in abortion forums to analyze the issues faced by individuals. The forums were then quantitatively analyzed to determine which problems were most prevalent., Methods: The most popular abortion forums were identified. A preliminary thematic analysis was conducted for the qualitative phase, followed by a manual quantitative analysis. Two independent researchers reviewed forum posts, categorizing them into specific themes., Results: An analysis of 13,397 responses from 370 threads across 4 forums revealed "Abortion Process Progression" as the most discussed theme, highlighting a strong demand for information, emotional support, and medical guidance. The highest percentage of threads (162/886, 18.3%) focused on the need for mental support and the desire to have someone in contact during the abortion process. Concerns about the effectiveness of the termination also emerged as a significant topic, accounting for 83 of the 886 (9.4%) discussions. "Emotional and Psychological Aspects" and "Medical and Pharmacological Aspects" were also significant, highlighting the need for holistic care. Anxiety and fear related to the process were frequently discussed, accounting for 60 of the 886 (6.8%) responses. The issue of isolation and lack of support was also a common topic, appearing in 30 of the 886 (3.4%) threads. Notably, "Social and Ethical Perception" accounted for only 13 of the 886 (1.5%) responses and appeared in just 13 threads., Conclusions: This study highlights the critical need for information and support for women navigating abortion, particularly in regions where access is restricted. It emphasizes the importance of addressing the multifaceted challenges women face and calls for policy changes and strengthened support networks to improve the health and rights of women, as well as all those seeking gynecological care in abortion contexts. Further research is encouraged to refine and expand support strategies., (©Krzysztof Bartosz Klimiuk, Amelia Kot, Ewa Majcherek, Katarzyna B Kubiak, Łukasz Balwicki. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 09.12.2024.)

Study Objective: To determine clinician factors associated with discussing abortion during pregnancy options counseling among adolescents., Methods: We recruited and surveyed a convenience sample of U.S. clinicians who care for pregnant adolescent patients (N=146). Clinicians were recruited at a national conference, through listservs, and via a physician mailing list. We used chi-square tests to analyze differences in our primary outcomes (routinely discussing abortion, routinely providing abortion referrals, and not routinely advising patients seeking abortion against termination) by clinician demographics, beliefs, and practice settings., Results: Fifty-seven percent of clinicians reported routinely discussing abortion with adolescent patients, 58% routinely referred for abortion, and 76% did not routinely advise against termination. Female gender, pediatric specialty, and practicing in an academic setting were associated with routinely referring for abortion and not routinely counseling against abortion (p<0.05). Additionally, state abortion laws at the time of the survey were associated with abortion discussion and referrals. Having "a personal objection to abortion" or "belief that abortion will harm patients" were negatively associated with each outcome (p <0.05)., Conclusion: Clinician demographics and personal beliefs were associated with differences among counseling. Although this was a small exploratory study, our findings highlight important clinician-level barriers to adolescents' access to abortion counseling and care., Competing Interests: Declaration of competing interest The authors have no conflicts of interest relevant to this article to disclose., (Copyright © 2024. Published by Elsevier Inc.)

The termination of a pregnancy in the first trimester is regulated by law. Guidelines serve the purpose of presenting the current state of medical science in order to enable the best possible care. S3 guidelines represent the highest level of guideline development and contain all elements of systematic development, including systematic research, evaluation of the evidence, and structured consensus-building using formal technology. The existing S2k guideline is to be raised to an S3 level. For this purpose, the Institute for Quality and Efficiency in Health Care (IQWiG) conducted an evidence search on eight central questions. The result showed a predominantly very poor level of evidence. The article describes the development of the S3 guideline and the existing problems and limitations., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: A. Scharl und S. Wallwiener bestätigen, dass keine materiellen Interessenkonflikte bestehen. Die Autoren sind Ärzte für Frauenheilkunde und Geburtshilfe und leiten Kliniken. Sie sind Vorstandsmitglieder von medizinischen Fachgesellschaften auf dem Gebiet der Frauenheilkunde und Geburtshilfe. Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien., (© 2024. Springer-Verlag GmbH Deutschland, ein Teil von Springer Nature.)

Introduction: Barriers to accessing abortion care can delay access to services, which can lead to delayed abortion and health risks. Barriers include geographical accessibility, confidentiality, waiting times, stigmatization, poor or inaccessible information and the cost of abortion. This article examines barriers to accessing abortion care in Germany. This includes barriers in the availability and accessibility of care services, access to information, costs associated with abortion and organisational barriers., Methods: The analyses are based on data from an online cross-sectional survey of 594 women in Germany who had an unwanted pregnancy terminated, which was conducted as part of the ELSA Study in 2021 and 2022., Results: The findings indicate that access to abortion care in Germany is associated with various barriers for many women. Of the respondents, 80.1% reported at least one barrier to accessing abortion, 65.5% reported more than two barriers and 40.5% reported three or more barriers. In particular, the non-disclosure of the procedure and the associated fear of stigmatisation represented hurdles for many participants., Discussion and Conclusion: The results of the study underline the need to improve access to safe abortions. Reducing access barriers therefore includes the decriminalisation of abortion, a comprehensive care structure, financial support services, improved information services and the reduction of stigmatisation and discrimination., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: D. Hahn, R. Torenz, I. Thonke, S. Eckardt, M. Schneider, A. Wyrobisch-Krüger, U. Busch, C. Helfferich, T. Knittel, M. Böhm, P. Brzank, C. Knaevelsrud, S. Krumm und S. Schumacher geben an, dass kein Interessenkonflikt besteht. Die Befragungen von ungewollt Schwangeren wurden mit Zustimmung der zuständigen Ethik-Kommission der Hochschule Fulda (positives Votum vom 27.04.2021, Az.: 3.1.9.2-kkm), im Einklang mit nationalen Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patient/-innen liegt eine Einverständniserklärung vor., (© 2024. The Author(s).)

Pregnancy termination is still a sensitive and continuing public health issue due to several political, economic, religious, and social concerns. This study assesses the applications of machine learning models in the prediction of pregnancy termination using data from eleven national datasets in East Africa. Nine machine learning models, namely: Random Forests (RF), Decision Tree, Logistic Regression, Support Vector Machine, eXtreme Gradient Boosting (XGB), AdaBoost, CatBoost, K-nearest neighbor, and feedforward neural network models were used to predict pregnancy termination, with six evaluation criteria utilized to compare their performance. The pooled prevalence of pregnancy termination in East Africa was found to be 4.56%. All machine learning models had an accuracy of at least 71.8% on average. The RF model provided accuracy, specificity, precision, and AUC of 92.9%, 0.87, 0.91, and 0.93, respectively. The most important variables for predicting pregnancy termination were marital status, age, parity, country of residence, age at first sexual activity, exposure to mass media, and educational attainment. These findings underscore the need for a tailored approach that considers socioeconomic and regional disparities in designing policy initiatives aimed at reducing the rate of pregnancy terminations among younger women in the region., Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Ethics approval and consent to participate: Since this study was done using a secondary data source, participants’ consent is not applicable. However, a permission letter and approval were obtained from DHS which allows us to use the data., (© 2024. The Author(s).)

This article argues that mid-century Surrealist German author Unica Zürn's writing on the fetus and pregnancy anticipates New Materialist analyses of the liveliness of matter and the interactions of biology and history. Using philosopher-physicist Karen Barad's theories of Agential Realism as a lens, I unite a close reading of key moments in Zürn's oeuvre with an examination of medical practices in the midcentury and the lingering history of Nazi eugenics, demonstrating how politics and science come to both shape and deform the body in Zürn's prose. Through the interactions of both language and material, the bodies of the mother and fetus begin to double each other, and holocaust atrocities and abortion practices take on uncanny resonances., Competing Interests: Declarations. Ethical Approval: N/A Informed Consent: N/A Conflict of Interest: The author declares no competing interests., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

In January 2023, the "S2k guideline on abortion in the first trimester" of the Association of Scientific Medical Societies ("Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V.", AWMF) was published, which was commissioned by the Federal Ministry of Health ("Bundesministerium für Gesundheit", BMG). The guideline deals with surgical and medical abortion after counseling, with criminological or medical indication in the first 14 weeks of pregnancy, based to the last menstrual period. In this review article, based on this guideline, the procedures for medical and surgical abortion are compared as well as the advantages and disadvantages of the two methods. Clinical and practical aspects of preparation and implementation, complication management, and immediate aftercare for abortion are presented., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: M. David gibt an, dass kein Interessenkonflikt besteht. Bei der Erstellung des Artikels wurde keine KI benutzt. Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien., (© 2024. The Author(s).)

Background: Infectious diseases, particularly the Goatpox virus (GTPV) from the Poxviridae family, significantly impact livestock health and agricultural economies, especially in developing regions. Recent GTPV outbreaks in previously eradicated areas underscore the need for effective control measures, with vaccination being the most reliable strategy. This study investigates the effects of administering standard and double doses of live attenuated goatpox vaccine in pregnant Murcia-Granada goats, a non-native breed in Iran, to determine optimal vaccination protocols., Results: In 2018, 400 healthy and pregnant Murcia Granada goats imported from Spain were divided into groups of 200 and vaccinated with either a standard dose (0.5 ml) or a double dose (single 0.9 ml injection) of live attenuated goatpox vaccine. Post-vaccination, the goats were monitored daily for clinical signs of infection, with samples collected for PCR analysis to detect the presence of GTPV strains. In group A, which received the standard vaccine dose, no abortions or vaccine-related side effects were observed, and body temperatures remained normal. In group B, administered a double dose, 37% of the goats experienced abortions, displaying signs of GTPV infection, such as skin lesions (pox lesions) and increased body temperatures. Molecular analysis confirmed the vaccine strain of GTPV as the infection source, ruling out external contamination. Statistical analysis showed no significant differences in abortion rates concerning gestational age or t he age of the pregnant goats., Conclusion: The study highlights the importance of adhering to standard vaccine dosages in pregnant Murcia Granada goats to prevent adverse outcomes like abortions. This study emphasizes the necessity to review and revise vaccination protocols tailored to specific breeds and varying maintenance conditions, including pregnancy and outbreak scenarios. These findings stress the necessity for cautious and tailored vaccination strategies to ensure the safety and efficacy of vaccines in different goat breeds., Competing Interests: Declarations. Ethics approval and consent to participate: The protocol for this study was approved by the Internal Ethics Committee of the Faculty of Veterinary Medicine, University of Tehran (Protocol number IR28786/2). Additionally, all procedures involving the handling and care of the goats adhered to the international guidelines outlined in the Terrestrial Animal Health Code [41]. Informed consent was secured from the owner of the imported goats following a comprehensive explanation of the vaccination procedure and research goals. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Compared to first trimester abortions, those in the second trimester significantly contribute to maternal morbidity and mortality, particularly in low- and middle-income settings where access to safe second trimester abortion services is restricted. This study aimed to evaluate the prevalence and factors associated with induced second trimester abortions in India., Data and Methods: Retrospective calendar data for 7,696 women aged 15-49 years from fifth round of National Family Health Survey (2019-2021) was used for the study. Bivariate analysis was conducted to determine the prevalence of second trimester abortion, while logistic regression was utilized to model the factors associated with second trimester abortion., Results: thirteen percent of all women who underwent an abortion had delayed their termination till second trimester. A significant proportion of women without children and without a male child were observed to have a high rate of delayed termination. The likelihood of terminating the pregnancy at an advanced gestational stage was also found to be higher among women who had no children or a male child., Conclusions: The findings emphasize the urgent need to address son-preference prevalent in certain regions of India. Again, to improve the reproductive health of women in India accessible and comprehensive abortion care is imperative to prevent delays that could exacerbate complications and add many fold risks to women's health. Furthermore, there is a need for strengthened governmental initiatives, especially targeting underprivileged communities, to encourage the uptake of contraceptives., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Abortion restrictions affect access to reproductive health care. Research has demonstrated that abortion restrictions (policies that restrict access to abortion services or cause abortion clinics to close) result in reductions of and delays in abortions. We leverage two population-based datasets to investigate the effects of mandatory waiting periods (MWPs), a restrictive state abortion policy, on the prevalence of intimate partner violence (IPV), one of the most common types of crime and a highly prevalent and costly public health problem, using data from the National Incident-Based Reporting System and Uniform Crime Report - Supplemental Homicide Reports. We hypothesize that MWPs increase the prevalence of IPV through changes in financial strains, negative health consequences, and intra-household power dynamics. Using difference-in-differences, event study, and methods accounting for staggered treatment timing, we find that MWPs are associated with increases in IPV. Our findings are valuable for policymakers in today's post-Dobbs environment., Competing Interests: Declaration of competing interest We graciously acknowledge funding from the large, anonymous, philanthropic family organization that supports the Collaborative for Reproductive Equity (CORE) at University of Wisconsin-Madison. We also acknowledge funding from the University of Wisconsin-Madison Fall Competition. We have no conflicts of interest to report., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Since the recent US Supreme Court decision in Dobbs v. Jackson Women's Health Organization, people across the country have experienced large sudden changes in their access to abortion care. In this paper, I look to the history of abortion access in the United States to inform predictions for this new future. I study the effects of targeted regulations on abortion providers (TRAP laws) on a variety of maternal and infant health outcomes, using variation in the timing of policy adoption across states and a direct measure of the distance to an abortion provider. I implement difference-in-differences techniques across outcomes from restricted-use microdata on the universe of US births. I find that TRAP laws lead to 11-16 % increased rates of hypertensive disorders of pregnancy. Additionally, I find evidence that TRAP laws widen existing disparities in adverse infant health outcomes across parental race. These results demonstrate the potentially wide-ranging health effects of restricting access to abortion., (Copyright © 2024. Published by Elsevier B.V.)

Background: For women seeking legal abortion care, access to information and care options is not transparent in Germany. This can affect health and complicate the decision-making process. In its guideline, the WHO recommends the use of evidence-based information to enable women to make informed decisions. This qualitative study aims to assess preferences and decisional needs of women in Germany., Method: For the needs assessment, a qualitative study based on semi-structured guided interviews was conducted with pregnancy conflict counsellors and women who terminated a pregnancy in the past five years in Germany. These data were supplemented with social media group postings of women with pregnancy conflict experiences. All data were analysed using content-structuring analysis according to Kuckartz., Results: Three women who had undergone an abortion and two pregnancy conflict counsellors were interviewed. In addition, 89 posts from a closed social media group were analysed. Three main categories were identified: women's categorisation in value systems, factors influencing the experience of the care process and information needs of women facing conflict situations in connection with their pregnancy ("pregnancy conflict"). Abortion is considered to be stigmatised, so women rarely use existing counselling services. Overall, there is a high need for information and support among those seeking care. Concerns exist, especially with regard to the methods of abortion. The results of the study also indicate a burden caused by fragmented care, which requires a high degree of self-organisation of women., Discussion: The care situation in Germany does not meet the recommendations of the WHO guideline on safe abortion. The results indicate that care close to home and with an abortion procedure that meets women's individual preferences and thus complies with their self-determination has not yet been achieved in Germany., Conclusion: Neutral and evidence-based information could be helpful to enable women to make informed decisions and reduce anxiety. It would also be desirable to increase the opportunities for women to talk about their experiences in a protected environment., (Copyright © 2024. Published by Elsevier GmbH.)

Background: Parvovirus B19 (B19 V) infection during pregnancy can cause adverse fetal outcomes. Our aim was to characterize both clinical and asymptomatic maternal and neonatal cases by studying virological and serological markers of B19 V infection, and to sequence the complete genome of the circulating virus in Argentina., Methods: Symptomatic patients were included based on maternal and/or fetal-neonatal signs attributable to B19 V infection during gestation. Pregnant patients were analyzed in either the timely diagnosis group (TD, samples obtained when symptoms were present and infection was suspected) or the retrospective diagnosis group (RD, samples collected immediately postpartum), and newborns were analyzed at birth. A sample of asymptomatic individuals was also analyzed. Diagnostic tests (PCR/qPCR/serology) and sequencing were performed on archived serum samples from 2018 to 2023, and clinical data were obtained from medical records., Results: We studied 328 symptomatic patients, including 185 pregnant patients (73 TD and 112 RD) and 143 newborns. Among them, we identified 27/328 (8.2 %) positive cases (B19V+): 12/73 (16.4 %) in the TD group, 6/112 (5.4 %) in the RD group, and 9/143 (6.3 %) newborns. Within the 77 mother-newborn pairs included, there were 8 (10.4 %) B19 V infections and 6 cases of vertical transmission. Additionally, B19 V infection was detected in 26/310 (8.4 %) asymptomatic patients. Phylogenetic analysis identified genotype 1a as a circulating strain in Argentina., Conclusions: Our findings highlight the need to raise awareness and enhance diagnostic approaches in Argentina to more effectively identify and manage B19 V infections during pregnancy in our region., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper, (Copyright © 2024. Published by Elsevier B.V.)

AhR knockout mice are not completely infertile; however, they do experience decreased litter sizes after repeated pregnancies. This study revealed that the decrease in the number of live births is partly due to fetal deaths leading to miscarriages. Interestingly, fetal mortality was found to be linked only to maternal AhR gene defects and not the fetal genotype. Furthermore, we observed no significant changes in litter sizes in allogenic pregnancy, where AhR-KO female mice were crossed with ICR male mice. The results indicated that the absence of AhR in the dams affected the expression of immune tolerance-related genes in both the placenta and fetus. Specifically, FoxP3 and indoleamine 2,3-dioxygenase-1 (IDO1) mRNA levels were lower in the placentas of AhR-KO dams than in those of wild-type dams. Moreover, there were elevated levels of IL-1β and IFN-γ mRNA in the placentas of the AhR-KO dams, which indicated increased inflammation. However, the mRNA expression levels of IL-6 and IDO1 were low despite the elevated mRNA levels of IL-1β and IFN-γ, which may be because AhR is directly involved in IL-6 and IDO1 transcription. These findings imply that in AhR-KO mice, fetal death may be attributed to the disturbance of fetal-maternal immune tolerance as a result of increased inflammation and reduced IDO1 and FoxP3 mRNA levels., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

The Roe v. Wade decision was overturned in the United States in 2022. This implies that while abortion remains legal in most jurisdictions, it is no longer a constitutional right, thus paving the way for making it illegal. Ever since the Roe v. Wade decision, there have been bombings and other violent attacks against abortion providers and abortion clinics, claiming some fatal victims. The overwhelming majority of anti-abortion activists condemn such violence. At the same time, most anti-abortion activists consider the fetus a person, and ultimately believe that abortion is a form of murder. In this article, I argue that if abortion is murder, then anti-abortion violent activists have moral license to bomb abortion clinics. To do so, I rely on the principles of Just War theory. Ultimately, I rely on a modus tollens argument to prove that abortion is not murder: if abortion is murder, then activists have moral justification in bombing abortion clinics; activists do not have moral justification in bombing abortion clinics; therefore, abortion is not murder. Apart from attempting to prove that abortion is not murder, I also attempt to show the incoherence of the anti-abortion view., Competing Interests: Declarations. Conflict of interest: The author declares no conflict of interest., (© 2024. The Author(s) under exclusive licence to Monash University.)

Introduction: In the era of Dobbs, legality of abortion care in the United States depends upon state law. Even before Dobbs, while abortion remained legal mounting restrictions and debate surrounding legal abortion could have led to confusion about abortion legality and discouraged patients from accessing legal abortion. We hypothesized an association between believing abortion is illegal or uncertainty about legality with later timing of abortion care., Methods: We surveyed patients seeking abortion care in Ohio, West Virginia, and Kentucky from April 2020 to April 2021. We asked about their understanding of abortion legality at the time they were first deciding to have an abortion. Using unconditional logistic regression models, we examined associations between beliefs about abortion legality (measured as belief that abortion is legal or sometimes legal versus. illegal or unsure) and timing of abortion care (measured as trimester of abortion)., Results: Over half (57%) of the 1,479 patients who met eligibility criteria and completed the survey believed abortion was always legal, 21% thought abortion was sometimes legal, 12% believed abortion was illegal, and 10% did not know. Most (92%) had a first trimester abortion (<14 weeks gestation). Belief that abortion was illegal, or uncertainty about abortion legality, was not significantly associated with second trimester abortion care (unadjusted odds ratio [uOR]: 0.78, 95% confidence interval [CI]: 0.50-1.20). This association did not change meaningfully after adjusting for demographic and clinical variables (adjusted OR [aOR]: 0.83, 95% CI: 0.51-1.33)., Discussion: More than one in five patients presenting for abortion care in three abortion-restrictive states prior to Dobbs erroneously believed that abortion was illegal or were unsure. Understanding of legality was not significantly associated with timing of abortion care. These misunderstandings could escalate under Dobbs., (© 2024 The Author(s). Perspectives on Sexual and Reproductive Health published by Wiley Periodicals LLC on behalf of University of Ottawa.)

Despite significant progress in the legalization and decriminalization of abortion in Australia over the past decade or more recent research and government reports have made it clear that problems with the provision of services remain. This essay examines such issues and sets forth the view that such issues can and should be seen as (bio)ethical concerns. Whilst conscientious objection-the right to opt-out of provision on the basis of clear ethical reservations-is a legally and morally permissible stance that healthcare professionals can adopt, this does not mean those working in healthcare can simply elect not to be providers absent a clear ethical rationale. Furthermore, simple non-provision would seem to contravene the basic tenants of medical professionalism as well as the oft raised claims of the healthcare professions to put the needs of patients first. Recognizing that much of the progress that has been made over the past three decades can be attributed to the efforts of dedicated healthcare professionals who have dedicated their careers to meeting the profession's collective responsibilities in this area of women's health and reproductive healthcare, this paper frames the matter as a collective ethical lapse on the part of healthcare professionals, the healthcare professions and those involved in the management of healthcare institutions. Whilst also acknowledging that a range of complex factors have led to the present situation, that a variety of steps need to be taken to ensure the proper delivery of services that are comprehensive, and that there has been an absence of critical commentary and analysis of this topic by bioethicists, I conclude that there is a need to (re)assess the provision of abortion in Australia at all levels of service delivery and for the healthcare professions and healthcare professionals to take lead in doing so. That this ought to be done is clearly implied by the healthcare profession's longstanding commitment to prioritizing the needs of patient over their own interests., Competing Interests: Declarations. Competing interests: The author has no competing interests., (© 2024. The Author(s).)

Background: , an obligate intracellular bacterium, is the etiological agent of Q fever in humans and one of the causes of abortion in small ruminants. Although coxiellosis is considered an exotic disease, there are a few reports in Mexico. Coxiella burnetii , an obligate intracellular bacterium, is the etiological agent of Q fever in humans and one of the causes of abortion in small ruminants. Although coxiellosis is considered an exotic disease, there are a few reports in Mexico. Methods: The objective of this work was to determine the presence of C DNA in vaginal samples from sheep that presented abortion and ram semen. A total of 180 vaginal exudate samples and 20 semen samples were obtained from five Central and Southern States of Mexico. Total DNA was extracted from vaginal swabs and burnetii DNA in vaginal samples from sheep that presented abortion and ram semen. A total of 180 vaginal exudate samples and 20 semen samples were obtained from five Central and Southern States of Mexico. Total DNA was extracted from vaginal swabs and C . burnetii was identified by PCR amplification and sequencing of the IS 1111 insertion sequence. Results and Conclusion: In total, 110 (110/180) vaginal samples and 12 (12/20) semen samples were positive for C . burnetii . This is the first report of C . burnetii in sheep that aborted and in ram semen in Mexico.

Purpose: Annually, approximately 31,000 people experience a termination of pregnancy (TOP) in the Netherlands. In 2021, about one-third of them chose medical termination of pregnancy (MTOP). We explored experiences with MTOP and to what extent expectations, pain, and counselling in the clinic are associated with satisfaction with MTOP., Materials and Methods: A retrospective cross-sectional study was conducted using an online questionnaire. We included 138 respondents, ≥16 years, who chose MTOP (September 2020-March 2022)., Results: The majority of respondents experienced MTOP more positively than expected or as expected (67%). For 24%, the experience was more negative than expected. In the event of another TOP, half of these respondents would hesitate to choose or would not choose MTOP, mainly due to physical side effects. The majority of respondents (73%) would choose MTOP again. Their main motivation was self-determination during treatment. Respondents cited four key elements: pain, intensity of experience during and after treatment, blood loss, and duration. Correspondence between MTOP expectations and experiences was associated with satisfaction with MTOP, while pain and satisfaction with counselling were not., Conclusions: The majority of respondents were satisfied with MTOP and would choose the treatment again. Non-correspondence between expectations and experiences negatively affected satisfaction with MTOP. This highlights the importance of managing expectations by providing accessible information about the variety in expectations and experiences to patients with a focus on key elements of the experience.

Objectives: We tested abortion messaging to develop evidence-based communication recommendations for doctors who provide abortion care., Study Design: We conducted an online survey in a nationally representative sample of 1215 people, using National Opinion Research Center's Amerispeak Panel. We surveyed participants before and after viewing two brief videos featuring doctors who provide abortion care speaking about their work. Doctors' comments were grounded in strategic communications and applied psychology research, and emphasized caregiving roles, avoided political-sounding punditry, and acknowledged abortion's complexities. We assessed participants' characterizations of doctors, and how these characterizations impact support for abortion restrictions and views on abortion legality. We analyzed pre-post data using descriptive statistics, t tests, and multivariable regression., Results: Postmessaging more participants endorsed positive descriptors of doctors who provide abortion care (p < 0.001, t = 8.99); fewer endorsed negative descriptors (p < 0.001, t = 10.32). Increased postmessaging endorsement of positive descriptors predicted declines in support for abortion restrictions (adjusted odds ratio = 1.69, p < 0.01); decreased endorsement of negative descriptors did not. After messaging, 37% of respondents said their views of doctors who provide abortion care made them less likely to support abortion restrictions, compared to 14% before (p < 0.001, t = -6.9). After messaging, there was more overall support for legal abortion and less for abortion being mostly illegal (46% to 48% and 24% to 22%, p < 0.001; t = -4.11)., Conclusions: When doctors who provide abortion care use messaging recommendations that include speaking about abortion's complexities and avoiding political-sounding punditry, they generate more support for legal abortion and less for restrictions., Implications: The voices of doctors who provide abortion care shape public opinion. When doctors speak from caregiving perspectives, avoid punditry, and acknowledge abortion's complexities, they generate more support for legal abortion and less for restrictions. However, audiences may not be aware a priori that ideas of doctors shape their views., (Copyright © 2024 Elsevier Inc. All rights reserved.)

On January 30, 2024, over 300 researchers filed an amicus brief in FDA v. Alliance for Hippocratic Medicine, a United States (US) Supreme Court case concerning the regulatory status of mifepristone, one of two drugs used in medication abortion. In this Comment we summarize the legal challenge, responses from the FDA and drug manufacturer to these challenges, oral arguments presented before the Court, and the implications of the Court's decision on access to mifepristone in the US. We also summarize the content of the accompanying amicus brief., (© 2024 University of Ottawa.)

Purpose: To assess young people's interest in advance provision (AP) of medication abortion-receiving mifepristone and misoprostol from a clinician in advance for their future use., Methods: From November 2022-August 2023 we administered an electronic survey regarding advance provision to patients assigned female at birth at four Bay Area youth-serving clinics., Results: Among 152 people ages 14-24 years (mean 17.9) surveyed, 73.7% (95% CI, 65.9%-80.5%) supported and 46.1% (95% CI, 37.9%-54.3%) were interested in the AP model. AP interest was higher among people who experienced three or more difficulties trying to access reproductive healthcare (70.6% [95% CI, 44.0%-89.7%]) and who experienced food or housing insecurity (60.3% [95% CI, 46.6%-73.0%]). Most youth (81.6%) had a safe place to store the pills for later use; this proportion was significantly higher among people ages 18-24 years (88.5%) than teens ages 14-17 years (74.3%, P = .025). The most common perceived advantages of AP included being able to have the abortion earlier in pregnancy (61.8%), privacy (57.9%) and convenience (50.7%). Common disadvantages noted included concern that people might take the pills incorrectly (50.0%) or lose the pills (40.1%)., Conclusions: Young people have considerable interest in AP of medication abortion. Further research is needed to document the AP model's feasibility, clinical outcomes, and effect on access for adolescents., (Copyright © 2024. Published by Elsevier Inc.)

Objective: Analyze changes in abortion practices during the early coronavirus disease 2019 (COVID-19) pandemic., Study Design: Sites recruited by Society of Family Planning participated in a longitudinal descriptive analysis comprising three surveys between February and October 2020. Average monthly total and medication abortion volume was analyzed by χ 2 and linear regression., Results: Total average volume of abortion services did not change among participating sites (p = 0.79). Volume and proportion of medication abortion increased over the study period (p = 0.02, p < 0.01)., Conclusions: The early COVID-19 pandemic marked a shift toward medication abortion., Implications: Our findings are interlaced in a national trend predating the Dobbs ruling, likely accelerated by the COVID-19 pandemic., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objectives: To compare self-reported clinical outcomes following medical abortion with mifepristone and misoprostol sourced from either a pharmacy or health clinic., Study Design: We conducted a prospective, non-randomized, non-inferiority cohort study across four regions in Ghana, from high-volume pharmacies and health clinics. Participants seeking medical abortion (less than nine weeks' gestation) who met usual medical abortion eligibility criteria were recruited. Data collection included baseline surveys, follow-up phone interviews, and self-reported assessments of medical abortion outcomes. The study aimed to enroll 2000 medical abortion users (1000 from each source)., Results: Complete outcome data was available and analyzed from 1958 participants (of 2208 enrolled), with the adjusted risk difference of need for additional treatment to complete the abortion indicating non-inferiority of the pharmacy group compared to the clinic group [-2.3% (95% CI -5.3% to 0.7%)]. Both groups reported low rates of additional treatment (4.9%) and adhered similarly to the abortion regimen. Secondary outcomes showed no significant differences, with moderate acceptability in both groups (65.4% pharmacy, 52.3% facility). Adverse outcomes were rare: one ectopic pregnancy, one blood transfusion and no deaths or other major complications were reported., Conclusions: Accessing medical abortion pills directly from pharmacies without prior consultation from a provider demonstrated non-inferior self-reported clinical outcomes compared to seeking care from health clinics. The findings align with the growing global evidence supporting the safety and effectiveness of medical abortion self-care., Implications: This study contributes data which support future registration of over-the-counter use of medical abortion drugs up to nine weeks' gestation. Such measures could expand options for safe abortion care, especially in regions where unsafe abortion poses a substantial maternal health risk., Trial Registration: ClinicalTrials.gov (NCT03727308)., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Study Objective: As part of a larger study about pregnancy options counseling with adolescents, we interviewed women in the United States who chose abortion during adolescence about preferences and experiences regarding communication from healthcare professionals during abortion care., Design, Setting, and Participants: We conducted individual semi-structured interviews with women ages 18-35 years old who were pregnant before age 20 years old and chose abortion. We recruited participants through social media, a research registry, and flyers in healthcare facilities. We recorded and transcribed interviews. Two investigators coded interview transcripts using thematic analysis., Results: We conducted interviews with 17 US women (median age 32 years old, range 20-35 years old) from 11/2020-4/2021. The median age at time of abortion was 18 years old (range 14-19 years). The sample was 58% (n = 10) Caucasian and 65% (n = 11) heterosexual. Themes included: 1) Participants perceived options counseling before abortion as important and necessary but did not always feel they personally needed it. 2) Participants reported that clinicians including nurses, physicians, and other staff sometimes had poor bedside manner, which was not aligned with their perceived need for gentleness due to their adolescence. 3) Participants valued nonjudgmental communication including normalization of abortion care. 4) Participants desired privacy and confidentiality throughout their clinic appointment, but clinic logistics led to concerns about limited privacy. 5) Participants appreciated medically accurate information about abortion in plain language balancing safety and risk information for reducing fear before the procedure., Conclusion: Responses suggested specific best practices that healthcare providers can adopt to improve care for youth considering abortion., Competing Interests: Conflicts of Interest The authors have no conflicts of interest to disclose., (Copyright © 2024. Published by Elsevier Inc.)

Objectives: This study aimed to examine the characteristics of foreign-born abortion patients compared to those born in the Unites States and to explore whether barriers for foreign-born patients varied by state Medicaid coverage of abortion care., Study Design: We used data from the Guttmacher Institute's 2021-2022 Abortion Patient Survey, a national sample of patients obtaining clinic-based abortion care in the United States. We compared sociodemographic characteristics of foreign- and US born respondents, as well as barriers to care. Among foreign-born patients, we compared those in Medicaid coverage states vs states that restrict Medicaid coverage., Results: Some 12% of the 6429 respondents were born outside the United States. Compared to US born patients, they were less likely to have Medicaid coverage and more likely to be Asian/Native Hawaiian/Pacific Islander or Hispanic, to have no health insurance, and to have completed the survey in Spanish. In addition, foreign-born patients were more likely to report delays because they did not know where to get an abortion (18.3% vs. 12.6% for US born). Compared to foreign-born patients living in Medicaid coverage states, those in non-Medicaid states reported multiple barriers, particularly related to cost: respondents in non-Medicaid states were three times as likely to pay out of pocket for abortion (75.8% vs 27.4%) and five times more likely to rely on financial assistance (24.1% vs 4.8%)., Conclusions: Foreign-born abortion patients face knowledge and financial barriers to accessing abortion care compared to those who are US born, and these financial burdens are amplified for those living in non-Medicaid coverage states., Implications: Abortion patients born outside the United States may have overcome many obstacles to obtain care. Expanding state Medicaid coverage of abortion could reduce cost burdens for foreign-born populations., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Study Objective: To assess willingness to provide medication abortion among North American Society for Pediatric and Adolescent Gynecology (NASPAG) clinicians caring for adolescents and young adults (AYA) following Dobbs v. Jackson Women's Health Organization., Design: Cross-sectional online survey., Methods: Potential participants received an e-mail invitation via the NASPAG listserv. A 43-item questionnaire queried demographics, practice setting, abortion training and practice, willingness to provide medication abortion, potential or real barriers to providing medication abortion, and sentiments of abortion. Descriptive statistics, χ 2 , and Fisher's exact tests were used., Results: Of the 70 participants, 51% were willing to provide a medication abortion for an adolescent who requested it in their clinical practice. The most common barriers to providing medication abortion were legislative restrictions (47%) and dispensing pills from clinic (33%). Participants' willingness to provide a medication abortion differed by type of practice (P = .001), availability of mifepristone (P = .006), perception of state's abortion policy (P = .001), concern about legislative restrictions (P = .008), experience providing abortion (P = .04), and receipt of medication abortion training (P = .02). Willingness to provide medication abortion also differed based on various sentiments of abortion measured but not on opinion regarding legality of abortion for adolescents (P = .49)., Conclusions: Perception of state's abortion rights and concern about legislative restrictions influenced NASPAG clinicians' willingness to provide medication abortion for adolescents. Interventions to minimize legislative interference with medical care, increase abortion training, and implement medication abortion in pediatric settings may expand AYA medication abortion access., Competing Interests: Conflicts of Interest Statement K.F. is a consultant for Medicines360. No other authors have any conflicts of interest to disclose., (Copyright © 2024. Published by Elsevier Inc.)

The increased politicization of sexual and reproductive health has created barriers to medically necessary care. In absence of formal health care, social ties become critical sources of information and resources, yet the disclosure of stigmatized health needs carries significant risk. How do people navigate the risks and benefits of disclosure when seeking care for stigmatized needs? Drawing on original survey data (N = 153) and in-depth interviews (N = 55) with women who attempted a self-managed abortion, I first describe the distinct roles of weak and strong ties in women's health-seeking experiences. I then demonstrate how both partial disclosure and nondisclosure are critical tools for obtaining information, resources, and emotional support during periods of health-seeking. Findings advance understanding of disclosure as a continuum that can be strategically wielded by people with stigmatized needs to confront and evade stigma and surveillance from their networks, the state, and the formal health care system.

Introduction: Unintended pregnancies are a worldwide health issue, faced each year by one in 16 people, and experienced in various ways. In this study we focus on unintended pregnancies that are, at some point, experienced as unwanted because they present the pregnant person with a decision to continue or terminate the pregnancy. The aim of this study is to learn more about the decision-making process, as there is a lack of insights into how people with an unintended pregnancy reach a decision. This is caused by 1) assumptions of rationality in reproductive autonomy and decision-making, 2) the focus on pregnancy outcomes, e.g. decision-certainty and reasons and, 3) the focus on abortion in existing research, excluding 40% of people with an unintended pregnancy who continue the pregnancy. Method: We conducted a narrative literature review to examine what is known about the decision-making process and aim to provide a deeper understanding of how persons with unintended pregnancy come to a decision. Results: Our analysis demonstrates that the decision-making process regarding unintended pregnancy consists of navigating entangled layers, rather than weighing separable elements or factors. The layers that are navigated are both internal and external to the person, in which a 'sense of knowing' is essential in the decision-making process. Conclusion: The layers involved and complexity of the decision-making regarding unintended pregnancy show that a rational decision-making frame is inadequate and a more holistic frame is needed to capture this dynamic and personal experience.

Costa Rica prohibits abortion except under narrow circumstances to save the pregnant person's life. The country boasts historically strong support for social policy and human rights, while also presenting a complex and restrictive abortion access landscape. From September 2021 to March 2022, we conducted 23 interviews with obstetrician-gynecologist (OB/GYN) physicians, OB/GYN medical residents, and policy stakeholders to explore the socio-ecological influences on abortion access in Costa Rica. We sampled clinicians and policy stakeholders from the Universidad de Ciencias Médicas listserv through snowball sampling and conducted semi-structured in-depth interviews in Spanish. We identified limited access to comprehensive sexual health education, lack of support from interpersonal networks, inadequate provider knowledge and training, financial and migratory status, and both provider and community stigma as substantial barriers to abortion access. This study addresses a gap in published research around the social determinants of abortion in Costa Rica and sheds light on the attitudes and opinions of the medical and policy stakeholder communities about abortion access. The results highlight the need for expanded access to comprehensive sexual health education, abortion-related training for healthcare providers, and increased programming efforts, such as funding, outreach, and implementation, to ensure comprehensive reproductive health services are available and accessible, especially for vulnerable populations in Costa Rica.

Background: Limited evidence exists on the influence of hospital procedure volume, socioeconomic status, and comorbidities on surgical abortion outcomes., Objective: Our study aimed to assess the association between hospital procedure volume, individual and neighborhood deprivation, comorbidities, and abortion-related adverse events., Study Design: A nationwide population-based cohort study of all women hospitalized for surgical abortion was conducted from January 1, 2018 to December 31, 2019 in France. Annual hospital procedure volume was categorized into 4 levels based on spline function visualization: very low (<80), low ([80-300]), high ([300-650]), and very high-volume (≥650) centers. The primary outcome was the occurrence of at least one surgical-related adverse event, including hemorrhage, retained products of conception, genital tract and pelvic infection, transfusion, fistulas and neighboring lesions, local hematoma, failure of abortion, and admission to an intensive care unit or death. These events were monitored during the index stay and during a subsequent hospitalization up to 90 days. The secondary outcome encompassed general adverse events not directly linked to surgery., Results: Of the 112,842 hospital stays, 4951 (4.39%) had surgical-related adverse events and 256 (0.23%) had general adverse events. The multivariate analysis showed a volume-outcome relationship, with lower rates of surgical-related adverse events in very high-volume (2.25%, aOR=0.34, 95% CI [0.29-0.39], P<.001), high-volume (4.24%, aOR=0.61, 95% CI [0.55-0.69], P<.001), and low-volume (4.69%, aOR=0.81, 95% CI [0.75-0.88], P<.001) wh en compared to very low-volume centers (6.65%). Individual socioeconomic status (aOR=1.69, 95% CI [1.47-1.94], P<.001), neighborhood deprivation (aOR=1.31, 95% CI [1.22-1.39], P<.001), and comorbidities (aOR=1.79, 95% CI [1.35-2.38], P<.001) were associated with surgical-related adverse events. Conversely, the multivariate analysis of general adverse events did not reveal any volume-outcome relationship., Conclusion: The presence of a volume-outcome relationship underscores the need for enhanced safety standards in low-volume centers to ensure equity in women's safety during surgical abortions. However, our findings also highlight the complexity of this safety concern which involves multiple other factors including socioeconomic status and comorbidities that policymakers must consider., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: While there is increasing information regarding the occupational risks to pregnant physicians, there is inconsistent and limited subspecialty data. Physicians may be at increased risk for pregnancy complications due to occupational exposure, long work hours, nightshifts, and physical/mental demands. Additionally, little is known regarding the education physicians receive pertaining to pregnancy risks respective to their specialties as well as departmental/institutional support for pregnancy loss or complication. Therefore, a survey was developed and distributed across multiple academic sites to ascertain if there is an inherent occupation-associated risk of pregnancy complication(s) and/or pregnancy loss for anesthesiologists (ANES) when compared to obstetrician/gynecologists (OB/GYN)., Methods: A specialty-specific survey was distributed electronically to attending ANES and OB/GYN, via departmental listservs at six participating academic medical centers. Responses were collected from March to October 2022 and included demographic information, practice characteristics, education about pregnancy risks and details of pregnancy complications and loss. The primary comparison between specialty groups was the occurrence of at least one pregnancy complication and/or loss. Logistic regression was used to evaluate specialty outcome associations. Additionally, complication rates and types between specialties were compared using univariate and multivariable models., Results: The survey was distributed to 556 anesthesiology and 662 obstetrics-gynecology faculty members with 224 ANES and 168 OB/GYN respondents, yielding an overall 32.2% response rate. Of the survey respondents, 103 ANES and 116 OB/GYN reported at least one pregnancy. Demographics were similar between the two cohorts. ANES had higher gravidity and parity relative to OB/GYN and tended to be earlier in their career at first pregnancy ( p  = .008, <.001, and .043, respectively). The rate of any pregnancy complication, including loss, was similar between specialties (65.1% (67/103) vs. 65.5% (76/116), p  = .942). Of the respondents reporting at least one pregnancy, 56.7% of ANES and 53.9% of OB/GYN experienced a complication while at work. Obstetrician-gynecologists had higher use of reproductive assistance (28% (47/116) vs. 11% (20/103), p  < .001). There were no notable differences between cohorts for complications, prematurity, and neonatal intensive care admission. Forty-one percent (161/392) of total respondents recalled learning about occupational risks to pregnancy, and ANES were more likely than OB/GYN to have recalled learning about these risks (121/224 (54%) and 40/168 (23.8%), respectively, p  < .001)., Conclusions: ANES and OB/GYN had similar risks for pregnancy complications and loss. Anesthesiologists were more likely to recall receiving education regarding occupational risk to pregnancy, though fewer than half of all survey respondents recalled learning about these risks. Our survey results are similar to the previously identified higher rate of pregnancy complications and loss in female physicians while uncovering areas of potential knowledge gaps for which institutions and practices could strive to improve upon. More research is needed to examine the relationship between occupation and pregnancy risk pertaining to female physicians with the goal being to identify modifiable risk factors.

On January 30, 2024, over 300 researchers filed an amicus brief in FDA v. Alliance for Hippocratic Medicine, a United States (US) Supreme Court case that could have severely impacted access to mifepristone, one of the two drugs commonly used in medication abortion. The researchers summarize the legal challenges to the US Food and Drug Administration's (FDA's) original approval of mifepristone in 2000 and its 2016 and 2021 decisions modifying mifepristone's Risk Evaluation and Mitigation Strategy (REMS) Program and label, the responses from the FDA and drug manufacturer to the challenges, and the potential implications of the Court's decision on access to mifepristone in the US. The researchers detail how the FDA relied on a robust scientific record analyzing tens of thousands of patient experiences that conclusively demonstrated the safety and effectiveness of the changes to the mifepristone REMS Program and label and urge the Supreme Court to rely on the clear scientific record and preserve access to mifepristone without reimposing restrictions. What follows is a reprint of this brief., (© 2024 University of Ottawa.)

Background: The issue of whether abortion increases the risk of future mental health problems for women remains a debated topic, and there is a lack of evidence from large-scale studies conducted in China. This study aimed to investigate the potential associations between abortions, particularly repeated abortions, and the mental health status of postmenopausal women in Southwest China., Methods: The data were obtained from the baseline survey of a multi-center natural population cohort study in cooperated with medical consortia in Southwest China. A standard structured questionnaire was used to assess abortion status among women of childbearing age. The 7-item Generalized Anxiety Disorder Scale (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9) were used to evaluate psychological well-being. Subsequently, multiple logistic regression analysis was employed to examine the associations between the quantity and reasons for abortions and the mental health status of postmenopausal women., Results: A total of 9991 postmenopausal women were enrolled (mean age: 60.51 years), of whom 11.09% (1108 individuals) reported mental health problems (5.54% for depression and 8.27% for anxiety). Multiple logistic regression analysis revealed that, compared with women without any history of abortion, postmenopausal women who reported three or more abortions during their childbearing years were likely to have worse mental health conditions (OR [95% CI]: 1.37 [1.13, 1.67]). Additionally, women who reported a history of abortions for socio-economic reasons were also correlated with an increased risk of mental health issues after menopause (OR [95% CI]: 1.34 [1.08, 1.66])., Conclusions: Women who reported a history of three or more abortions were at an increased risk of experiencing mental health issues after menopause. Reproductive-age women should enhance their contraceptive awareness to prevent unintended pregnancies and subsequent abortions. Healthcare institutions are recommended to strengthen psychological counseling for women who have undergone abortions., Competing Interests: Declarations. Ethics approval and consent to participate: This study was approved by the ethical community of West China Hospital, Sichuan University. We confirmed that all methods were performed in accordance with relevant guidelines and regulations to protect human subjects. All participants read and signed written informed consent forms. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Objective: Antiphospholipid syndrome (APS) is among the autoimmune disorders caused by antiphospholipid antibodies, which provoke blood clots (thrombosis) in arteries and veins. It can also cause such complications as severe preeclampsia, miscarriage, premature birth, and stillbirth in pregnant women. We investigated the clinical and serological characteristics of antiphospholipid syndrome patients., Methods: This retrospective cross-sectional study was performed on those with persistently positive antiphospholipid syndrome. Data were extracted from medical records from the hospital information system(HIS) of rheumatology, neurology, cardiology, gynecology, general, and hematology wards of Ghaem Hospital and private rheumatology clinics of Mashhad, which were surveyed for 10 years (2008-2018)., Results: Of the 284 patients, 85.6% were female. The most common adverse outcome of pregnancy was miscarriage (68.1%). Non-criteria manifestations, including arthralgia and arthritis, were observed in 37.7% and 33.1% of the patients, respectively. Moreover, deep vein thrombosis (DVT) and cerebrovascular accident (CVA) (13%), organ gangrene (7.4%), and pulmonary thromboendarterectomy (PTE) and transient ischemic attack (TIA) (4.6%) were the most common thrombotic events in antiphospholipid syndrome patients. Deep vein thrombosis was seen in 70.3% of females (P=.005), and subclavian thrombosis was seen in 66.7% of males (P < .001). The risk of DVT in the presence of anti-cardiolipin Ab IgG positive was increased 2.7 times (CI: 95%, 1.2-5.7; P=.007), and it was increased 2.4 times in the presence of anti-β-2 glycoprotein 1 Ab IgG positive (CI: 95%, 1-5.8; P=.033) and 4.2 times in the presence of lupus anticoagulant Ab positive (CI: 95%, 1.9-9.1; P < .001). In patients with anti-β-2 glycoprotein 1 Ab IgG positive, the risk of placental dysfunction increased 4.3 times (CI: 95%, 0.9-20.3; P=.04)., Conclusion: This study's results found that this APS syndrome is mainly seen in women with a mean age of 38, and the most common symptoms associated with it are DVT, CVA, and abortion. Anti-β-2 Glycoprotein 1 Ab IgM and Anti-Cardiolipin Ab IgM were the most common positive antibodies in the patients.

Abortion has been legally permitted in England and Wales for over fifty years, yet this health service continues to be stigmatised within the health system. Stigma is a dominant focus of abortion research, but a structural stigma framework is rarely used to understand how abortion stigma is produced at a macro-level. This study explored how structural abortion stigma is produced and experienced in the health systems of England and Wales, and its influence on person-centred care, including choice of abortion methods. Data from in-depth interviews with abortion care-seekers in 2022-23 and from key informant interviews with abortion care providers, managers, and commissioners in 2021 were analysed using reflexive thematic analysis. From the perspectives of key informants, structural abortion stigma is produced through the avoidance of abortion by decision-makers, the permitting of conscientious objection, and the exclusion of abortion from mainstream healthcare. These factors create health system pressures which increase abortion service fragility. The resulting vulnerability of abortion services reduces access to person-centred care, including abortion method choice, which can reinforce individual-level stigma. There are tensions between care-seekers' experiences of specialist abortion care as less stigmatising, while the 'abortion clinic' becomes a site of stigma due to its segregation from mainstream healthcare. This research contributes to a structural understanding of abortion stigma by identifying some of the mechanisms through which structural stigma is produced within health system institutions, and how these forms of institutional stigma might be resisted or dismantled. Power is essential to the (re)production of structural stigma within the health system, which can reinforce individual-level stigma for both care-seekers and providers. Restrictions on method choice and the increasing reliance on medication abortion can be a product of structural abortion stigma, and these limitations on method choice can also reproduce stigma at the individual level., Competing Interests: Declaration of competing interest The author declares no competing interests., (Copyright © 2024 The Author. Published by Elsevier Ltd.. All rights reserved.)

Objective: Early pregnancy loss (EPL) affects 1 in 4 recognized pregnancies, yet often lacks patient-centered supportive care. This study assesses the feasibility and acceptance of a digital health tool to support those affected by EPL. The objectives are: 1) understand the experiences of those who have miscarried, 2) explore their methods of accessing health information, and 3) determine their preferences regarding digital tool content and design., Methods: This mixed-methods study included Canadian individuals aged 18-45 who self-reported to have experienced EPL up to 126 weeks gestation in the preceding two years. Recruitment was via social media and hospital posters. Participants completed an online survey and optional follow-up interview between September 2021 and April 2022. Survey responses were analyzed using descriptive statistics. Interview findings are presented in a separate paper. Local ethics approval was obtained., Results: Of the 185 survey respondents, 28% revealed that they are somewhat or very dissatisfied with the overall health care they received for their miscarriage. 39% are somewhat or very dissatisfied with how their mental/emotional health was addressed. Notably, 82% supported the development of a digital health tool for EPL care. 91% use the internet to access health information., Conclusion: Many participants reported dissatisfaction with their care following EPL but showed strong interest in a user-friendly digital tool that provides general information and mental health support. These findings, along with qualitative interview data, will guide the development and testing of the desired digital health tool, aiming to enhance patient experience and support following miscarriage., (Copyright © 2024. Published by Elsevier Inc.)

A primigravida in her 20s with a body mass index of 18 underwent dilation and evacuation at 22 and 4 weeks gestational age to manage an intrauterine fetal demise (IUFD) that had occurred 14 days ago. Hypoxaemia and vaginal bleeding developed 90 min postprocedure. Investigations demonstrated changes compatible with acute respiratory distress syndrome secondary to disseminated intravascular coagulopathy which was managed with intubation, mechanical ventilation and transfusion of blood products. Although the coagulopathy and respiratory failure resolved, severe acute kidney injury ensued resulting in acute tubular necrosis, severe labial oedema and the need for prolonged support with haemodialysis until kidney recovery 7 weeks later., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)