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The general public and abortion patients in the United States have misinformation about the risks of infertility associated with abortion, which may influence abortion care-seeking. The Google Ads Abortion Access Study was a national study of people considering abortion and searching online for information. Participants completed baseline and follow-up surveys, providing free text responses to questions about barriers and facilitators to abortion. We conducted an exploratory analysis of the free text responses related to fertility and used thematic analysis to identify concerns raised about links between abortion and future fertility. Of 864 participants who provided free text responses in the follow-up survey, 32 specifically mentioned fertility. Few expressed fear that complications from the abortion procedure would somehow lead to infertility; rather, most discussed complex and overlapping thoughts about how abortion factored into their reproductive life plans. These included age-related concerns, missing out on their "chance" to have a child, fear of being punished by God with infertility for having an abortion, and conflicting emotions if they had previously been told they were subfecund or infertile. Although previous research has focused on misinformation about the link between abortion and infertility, participants in this study rarely mentioned it as a concern. Researchers and practitioners should be attuned to the distinctions people make between infertility occurring as a result of abortion and other fears they might have about not achieving their future reproductive aspirations, ask questions, and provide counseling accordingly. [ABSTRACT FROM AUTHOR]

Objectives: Existing research has not thoroughly characterized the psychosocial costs associated with seeking abortion care in restrictive states. Our study seeks to fill this gap by analyzing the accounts of Ohio abortion patients from 2018 to 2019.Study Design: Using inductive and deductive approaches, we analyzed semi-structured in-depth qualitative interviews with 41 Ohio residents who obtained abortion care from one of three clinics in Ohio or Pennsylvania.Results: Ohioans seeking abortion care often experienced fear of judgment, interpersonal strain, and stress as a result of efforts to overcome pre-Dobbs financial, geographic, and timing challenges. Those who needed financial assistance or traveled more than an hour generally reported greater exposure to psychosocial costs.Conclusions: Participants in this study incurred a complex set of psychosocial costs. Psychosocial costs often resulted from, or were exacerbated by, the financial, geographic, and time-sensitive burdens that patients experienced seeking care.Implications: The psychosocial costs incurred by patients seeking abortion care may be exacerbated in restrictive contexts, especially those who do not have access to insurance coverage for care. Psychosocial costs associated with care seeking are likely to increase as states implement more severe restrictions post-Dobbs. To fully understand abortion costs, researchers must examine costs comprehensively, including both financial and psychosocial costs. [ABSTRACT FROM AUTHOR]

Objective: Despite overwhelming data supporting the safety of abortion care in the U.S., public perceptions of abortion safety vary widely. While evidence suggests that the public overestimates abortion risk, few studies have analyzed why people think abortion is safe or unsafe.Study Design: Using data from the Ohio Survey of Women, a representative survey of women aged 18 to 44 years with a residential address in Ohio, we examined responses to 2 questions about abortion safety perceptions: the first asked respondents to rate abortion safety in Ohio, and the second asked respondents why they chose this rating of abortion safety. We analyzed these responses with inductive and deductive approaches.Results: There were 2529 responses, of which 1368 (54%) provided a response to the open-ended question about abortion safety. From this subset, 529 gave open-ended responses indicating that they perceive abortion as safe, with 47% attributing this perception to the procedure being performed by a professional in a regulated environment. In contrast, 370 gave open-ended responses indicating that they perceive abortion as unsafe; the most common explanations referred to health risks (19%) and that safety depends on preexisting health conditions (19%).Conclusion: Many participants perceived abortion as safe because it is performed by professionals in a clinical environment or because of personal experiences with abortion. Those perceiving a lack of safety provided more varied responses, including that abortion was dangerous due to a detrimental effect on mental health or protesters at abortion clinics.Implications: We identified that women have a broad range of reasons for perceiving abortion as safe or unsafe. Providers should be aware of this diversity of abortion safety perceptions so that they can best engage with their patients.This updated characterization of pain experienced during an evidence-based medication abortion regimen may allow for better pain-related counseling, tailoring of opioid prescription practices, and improvement in patient satisfaction. [ABSTRACT FROM AUTHOR]

Objective: To describe changes in contraceptive method plans pre-appointment, after counseling, and post-procedure in patients having an abortion.Study Design: We reviewed electronic medical records of University of California, Davis Health patients who had an operating room abortion from January 2015 to December 2016. We excluded persons with procedures for fetal anomaly or demise. We extracted patient demographics and contraceptive plans reported at each encounter (telephone intake, pre-operative appointment, and day of abortion). We evaluated individual contraceptive plans across the encounters, identified patient characteristics that contributed to plan change, and created a multivariable logistic regression model for predictors of contraception method plan change from telephone intake to post-procedure.Results: The 747 patients had a mean gestational age of 16 4/7 ± 5 0/7 weeks with 244 (32.7%) <15 weeks and 235 (31.5%) ≥20 weeks. At telephone intake, 273 (36.4%) wanted a long-acting method (139 [50.9%] intrauterine device [IUD]; 99 [36.3%] implant; 35 [12.3%] unspecified), 11 (3.9%) permanent contraception, and 248 (33.2%) a less effective or no method; 215 (28.8%) stated they were undecided. Most (357/433 [82.4%]) patients who planned a reversible method based on the telephone intake obtained that or a similar method. Of the 273 patients planning a long-acting method, 258 (94.5%) received an IUD (158 [40.9%]) or implant (100 [36.6%]). Of the 215 undecided patients, 88 (40.9%) received an IUD and 55 (25.6%) an implant. No demographic factors predicted a change in method plan.Conclusions: Most patients will receive the method they initially identified at the telephone intake after an abortion, especially those planning an IUD or implant. Undecided patients are commonly open to discussing options. [ABSTRACT FROM AUTHOR]

Despite playing an integral part in sexual and reproductive health care, including abortion care, nurses are rarely the focus of research regarding their attitudes about abortion. A sample of 1,820 nurse members of the Association of Women's Health, Obstetric and Neonatal Nurses were surveyed about their demographic and professional backgrounds, religious beliefs, and abortion attitudes. Scores on the Abortion Attitudes Scale were analyzed categorically and trichotomized in multinomial regression analyses. Almost one-third of the sample (32%) had moderately proabortion attitudes, 29% were unsure, 16% had strongly proabortion attitudes, 13% had strongly antiabortion attitudes, and 11% had moderately antiabortion attitudes. Using trichotomized Abortion Attitudes Scale scores (proabortion, unsure, antiabortion), adjusted regression models showed that the following characteristics were associated with proabortion attitudes: being non-Christian, residence in the North or West, having no children, and having had an abortion. Understanding nurses' attitudes toward abortion, and what characteristics may influence their attitudes, is critical to sustaining nursing care for patients considering and seeking abortion. Additionally, because personal characteristics were associated with antiabortion attitudes, it is likely that personal experiences may influence attitudes toward abortion. A large percentage of nurses held attitudes that placed them in the "unsure" category. Given the current ubiquitous polarization of abortion discourse, this finding indicates that the binary narrative of this topic is less pervasive than expected, which lends itself to an emphasis on empathetic and compassionate nursing care. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic raised significant challenges for in-person healthcare provision, leading healthcare providers to embrace digital health like never before. Whilst changes were made as part of a public health response, many have now become permanent fixtures of the healthcare landscape, significantly altering the way care is provided not only for patients, but also for the healthcare professionals that provide care. In abortion care in England and Wales, previously stringent regulations on in-person care provision were relaxed to permit the use of telemedicine and self-administration of medications at home. These changes have since been made permanent. However, there remains opposition to remote abortion care pathways on the basis of safeguarding. Opponents argue that it is not feasible to effectively safeguard patients accessing abortion care remotely. We conducted a qualitative study using semi-structured interviews with abortion care providers in England and Wales. Participants were asked about their views and experiences of the transition to remote care provision, with a particular focus on how they adapted their safeguarding practice. In this article, we present three themes that highlight the changing roles of healthcare professionals in abortion care: (1) a challenging backdrop and resulting apprehension, (2) adaptive practices, and (3) the continued importance of professional curiosity. Across all three themes, participants reflected significantly on how changes were made and what they experienced in the period of transition to telemedicine. In particular, they discussed the changing nature of their professional roles amidst digitalisation. Our findings provide a basis for reflection on the increasing introduction of digital approaches to healthcare provision, highlighting points for caution and emphasising the need to involve professionals in the transition process to ensure vital buy-in. Through this, we articulate two novel understandings of digitalisation: (1) the impact of speed-associated pressures on professional adaptation during digitalisation, and (2) off-proforma safeguarding through telemedicine as a form of invisible non-routine work. • Telemedical abortion care pathways were introduced during the COVID-19 pandemic. • We interviewed providers about their experiences of safeguarding amidst the changes. • Most providers took to the changes well and favoured being involved in design. • Staff buy-in is essential in moving to more digital approaches to healthcare. • Co-production, involving staff, should be used when implementing telemedicine. [ABSTRACT FROM AUTHOR]

Objective: To examine attitudes toward prenatal testing and termination of pregnancy (TOP) among parents and obstetric providers in relation to their views on raising a child with disability.Methods: An explanatory sequential mixed methods study. A survey among 274 parents and 141 providers was followed by interviews with 26 parents and 10 providers. Using multivariate analysis, the relationships between attitudes were examined. Thematic analysis was used to identify the reasons behind the attitudes.Results: In comparison with providers, parents reported more positive attitudes toward raising a child with disability and more moral views about TOP. Providers reported more variations in attitudes toward offering prenatal testing and TOP. Significant associations were found between attitudes toward prenatal testing, raising a child with disability, reproductive autonomy, and TOP. Three major themes were identified: (1) meanings of parenthood from genetic tests; (2) views toward TOP and parental responsibility; and (3) implications of advanced extended prenatal genetic testing.Conclusions: Perceived social-cultural norms of disabilities and parental expectations of raising a child with disability influence decision-making regarding TOP.Practice Implications: As more conditions of the fetus are able to be detected, the social-cultural implications of the technology and disabilities need to be addressed in antenatal care. [ABSTRACT FROM AUTHOR]

Objective: To identify factors associated with choosing long-acting reversible contraception (LARC) (intrauterine device or contraceptive implant), when provided free-of-charge.Study Design: This register-based cohort study comprises all women living in the city of Vantaa in the Helsinki metropolitan area during 2013-2014, with information on LARC initiations retrieved from electronic health records. Since January 2013, women in Vantaa can receive their first LARC method free-of-charge at public contraceptive clinics. We performed multivariable regression to assess seven predictors based on literature and four predictors based on gynecological history for association with choosing LARC in this population.Results: In 2013-2014, 9669 women entitled to a free-of-charge method visited a public clinic and 2035 (21.0%) women initiated LARC. Factors most associated with LARC initiation included history of delivery (odds ratio [OR] 5.4, 95% confidence intervals [CI] 4.7-6.2) and induced abortion (OR 1.4, 95%CI 1.2-1.6), and no previous visit at the clinic (OR 1.3, 95%CI 1.2-1.5). Previous delivery was associated with LARC initiation in all age-groups (OR, 95%CI by age-group; 15-19 years: 10.8, 5.1-23.4; 20-24 years: 6.4, 4.9-8.3; 25-29 years: 6.7, 5.2-8.6; 30-44 years: 3.6, 2.9-4.6).Conclusion: History of delivery and induced abortion were strongly associated with choosing a LARC method, even though all women in the population were entitled to their first free-of-charge LARC method. The association was particularly strong among women less than 25 years of age.Implications Statement: Untargeted provision of free-of-charge LARC in public contraceptive services reached women with previous delivery or abortion well during the programs first years. However, as LARCs are recommended to all women, future research should focus on how uptake evolves and how to reach all women in need of long-term, effective contraception. [ABSTRACT FROM AUTHOR]

Globally, a growing proportion of induced abortions are medical abortions. The procedure has been hailed as a revolutionary technology, which, according to experts, has the potential to transform women's experiences of abortion and the way abortion services are accessed. Noticeably absent in the discourse, however, are women's voices. More specifically, there is a lack of understanding about what shapes women's preferences for medical abortion and the challenges they experience in accessing the drugs for the procedure. We conducted a systematic review of the literature to draw attention to these important issues which exist, but are often embedded within research highlighting other dominating aspects of medical abortions. A comprehensive search of four databases - supplemented by searching reference sections of selected articles, tracking their citations, and hand searching special editions on medical abortion - was conducted. A total of 45 peer-reviewed studies met our inclusion criteria. The studies were assessed for quality and analyzed using a critical interpretive synthesis approach. The findings revealed significant variations in women's preferences for surgical versus medical abortions. Country-specific abortion laws, implementing protocols, side-effects, rates of failures, and the need to verify the abortion shaped women's preference for abortion methods. Overall, women who preferred medical abortions did so because they perceived it as a 'natural' and safe procedure that can be self-conducted at home, thereby reducing their dependency on the health system. However, women face significant barriers to medical abortion care. These include legal requirements around type of provider, site of service, need for follow-up, providers' limited knowledge of the procedure, and preferences for surgical abortions. Borderless internet-based services have enabled some women to circumvent these barriers. Our review suggests that medical abortions are used by women either in countries where the health system is fully supportive or where the health system is completely disengaged, usually due to restricted abortion laws. In those countries where abortions are legal but often difficult to access due to health system barriers, women tend to prefer surgical abortions. [ABSTRACT FROM AUTHOR]

Objectives: To understand how having or being denied an abortion affects the likelihood of trying to become pregnant, overall pregnancy rates, and the rate and timing of an intended pregnancy in the future.Study Design: The Turnaway Study is a prospective cohort study of women who received or were denied a wanted abortion. Women were recruited from one of 30 US abortion facilities. We examined subsequent intended pregnancy among those who presented just under the facility's gestational limit and received an abortion (Near-Limit Abortion Group, n=413) and those who presented for abortion just beyond the facility's gestational limit, were denied an abortion and went on to parent the child (Parenting Turnaways, n=146). First, we modeled the probability of trying to become pregnant using multivariable mixed-effects logistic regression. We then used Cox proportional-hazards models to compare overall pregnancy rates and intended pregnancy rates over 5 years.Results: Parenting Turnaways had lower predicted probabilities of reporting trying to become pregnant in the first 1.5 years after birth/abortion than the Near-Limit Abortion Group. They also had lower pregnancy rates overall [40.4 per 100 woman-years vs. 53.5 per 100 woman-years, adjusted hazards ratio (aHR)=0.69, 95% confidence interval (CI): 0.54-0.89]. The 5-year intended pregnancy rate was low among both groups, but compared to the Near-Limit Abortion Group, Parenting Turnaways had a lower intended pregnancy rate (2.2 per 100 woman-years vs. 7.5 per 100 woman-years, aHR=0.29, 95% CI: 0.10-0.85).Conclusion: Being able to obtain a wanted abortion may enable women to have an intended pregnancy later.Implications: Ensuring that women can obtain an abortion for an unwanted pregnancy may enable them to have a subsequent pregnancy when they are ready to have a baby. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic changed our lives in many different domains, forcing people to adapt to countrywide lockdowns, school shutdowns, and business closures. The burden of the COVID-19 pandemic resulted also in deterioration of mental health. At the same time, political conflicts and social inequalities was reinforced and many people engaged in demonstrations to fight for their rights. This study examines whether collective acting for an important cause during the pandemic might mitigate the impact of both political tension related to anti-abortion restrictions and COVID-19 threats on mental health. We conducted a two-wave study with a representative sample of the Polish population, investigating the effect of participating in Polish pro-choice demonstrations on depressive and anxiety symptoms. Participating in protests attenuated the negative effects of COVID-19 threat and anti-abortion restrictions on mental health. Moreover, we found that the feeling of solidarity with other demonstrators and sense of agency derived from such demonstrations led to lower levels of depressive and anxiety symptoms. The results of the study indicate that participating in meaningful and value-oriented collective action may serve as a buffer against the detrimental effects of social and health threats. • Collective action mitigated negative effects of different threats on mental health. • Feeling of solidarity with protesters predicted lower levels of depression and anxiety. • Sense of agency among protesters also led to lower levels of depression and anxiety. [ABSTRACT FROM AUTHOR]

Anti-abortion legislation in the United States exploits misinformation and ignores medical definitions to curtail access to essential healthcare. Little is known about how individuals most likely to need this care define abortion, in general or as distinct from miscarriage, and how this might impact access to, utilization of, and experiences of care. Using mixed-method card sort and vignette data from cognitive interviews (n = 64) and a national online survey (n = 2009), we examined individuals' understandings of pregnancy outcomes including abortion and miscarriage. Our findings show that people hold varying ideas of what constitutes an abortion. Many respondents considered 'intent' when classifying pregnancy outcomes and focused on intervention to distinguish between miscarriages and abortions. Particularly, medical intervention was found as a defining feature of abortion. Lack of knowledge regarding pregnancy experiences and ambiguity surrounding early stages of pregnancy also influenced respondents' understanding of abortion. We find that abortion and miscarriage definitions are socially constructed and multi-layered. Advancing our understanding of abortion and miscarriage definitions improves reproductive health research by elucidating potential areas of confusion that may lead to misreporting of reproductive experiences as well as highlighting ways that blurred definitions may be exploited by abortion opponents. • How individuals define abortion is understudied, despite its complexity. • In interviews and surveys, respondents expressed varying understandings of abortion. • We found ambiguity around abortion, miscarriage, and other reproductive experiences. • Intent and medical intervention were key features of abortion definitions. • Many respondents lacked knowledge regarding common reproductive experiences. [ABSTRACT FROM AUTHOR]

Objective: To compare differences in televised abortion depictions from two time periods: 2005 to 2014, as examined in previous studies, and more recent depictions from 2015 to 2019.Study Design: Using a database of television abortion plotlines, we analyzed recent portrayals for character demographics, barriers, genre, and safety, calculated proportions, and compared to prior findings.Results: While recent portrayals shift towards reflecting some demographics of U.S. abortion patients, people of color, low-income people, and parents remain under-portrayed. Compared to prior depictions, recent plotlines are more likely to inaccurately depict abortion as easier to access than it is for the majority of U.S. abortion patients. However, recent depictions are also less likely to depict exaggerated and inaccurate medical complications of abortion. Abortion plotlines are increasingly appearing on comedies.Conclusion: Despite progress, there remain important ways television could improve abortion depictions.Implications: Content creators should continue to consider diversity, nuance, and medical and demographic accuracy in depicting abortion. [ABSTRACT FROM AUTHOR]

Objective: The decision to undergo a surgical or medical method of second-trimester termination for pregnancy complications should be preference-sensitive. Decision satisfaction has not been described in this population; understanding how women describe decision satisfaction in this setting could inform decision support efforts.Methods: We conducted qualitative interviews with women one to three weeks after termination who chose either a surgical or medical termination for fetal anomalies, pregnancy complications or fetal demise. We analyzed transcripts using modified grounded theory in an iterative manner with a generative thematic approach.Results: We interviewed 36 women (24 surgical and 12 medical). Subjects connected decision satisfaction with counseling experiences and their personal values, including (1) importance of adequate information, (2) autonomous decision making, and (3) choosing the method that facilitates coping.Conclusion: Offering women a choice between surgical and medical termination procedures in the setting of pregnancy complications is integral to decision satisfaction. Women in our study reported wanting this decision to be driven by their personal values.Practice Implications: Women should be able to choose between surgical and medical termination based on preference and not availability of services. Decision support from women's health providers should be based on values clarification and providing accurate information. [ABSTRACT FROM AUTHOR]

Objectives: Investigations into Crisis Pregnancy Centers (CPCs) have documented the provision of deceptive information about abortion, but it is unclear how many pregnant women actually visit CPCs and what impact visits have on their pregnancy decision-making.Study Design: We conducted a mixed-methods study. We surveyed patients at one of two local abortion clinics and three prenatal clinics in Southern Louisiana about whether they had visited a CPC for this pregnancy and conducted in-depth interviews with prenatal patients who reported a CPC visit about their experience.Results: We surveyed 114 abortion patients and 269 prenatal patients, and interviewed 12 prenatal patients about their CPC visit. Just 6% of abortion patients (n=7) and 5% of prenatal patients (n=14) visited a CPC for this pregnancy. Prenatal patients went to CPCs primarily for free pregnancy tests and reported receiving information about abortion from CPC staff that was inaccurate. They also generally recognized the CPC was antiabortion, ideologically Christian, and not a medical establishment. Only three had been considering abortion at the time of their visit and reported that the visit impacted their plan for the pregnancy. However, all three also faced additional barriers to abortion, including inability to find an abortion provider, difficulty securing funding, gestational limits, ambivalence about choosing abortion, and opposition to abortion from family members.Conclusions: We do not find evidence that pregnant women regularly seek CPC services or that CPCs persuade women who are certain abortion is the right decision for them to continue their pregnancies.Implications: Given little evidence that CPCs impact pregnant women's decision-making on a broad scale, future research should examine other aspects of CPCs, such as their role in the antiabortion movement and/or the impact of CPC visits on maternal health and birth outcomes among women who continue their pregnancies. [ABSTRACT FROM AUTHOR]

In a previous study (Van Ditzhuijzen et al., 2017) we investigated the incidence and recurrence of mental disorders 2.5 to 3 years post-abortion. The aim of the current study was to extend these findings with longer term follow up data, up until 5–6 years post-abortion. We compared data of women who had had an abortion of the Dutch Abortion and Mental Health Study (DAMHS) to women who did not have an abortion from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2) ( N total  = 2227). We used 1-to-1 matching on background confounding variables and measured post-abortion incidence and recurrence of common DSM-IV mental disorders (mood, anxiety, and substance use disorders) using the Composite International Diagnostic Interview (CIDI) version 3.0. After matching on confounding variables, abortion did not increase the likelihood that women had incident or recurrent mental disorders in the 5–6 years post-abortion (any incident mental disorder: OR = 3.66, p  = .16; any recurrent mental disorder: OR = 0.22, p  = .47). We found no evidence that experiencing an abortion increases the risk on new or recurrent mental disorders on the longer term. [ABSTRACT FROM AUTHOR]

Objective: We sought to explore the relationship between counseling quality, measured by shared decision making and decision satisfaction, and psychological outcomes (anxiety, grief, and posttraumatic stress) after second-trimester abortion for pregnancy complications.Study Design: We conducted a cross-sectional study of women who underwent second-trimester abortion for complications. We recruited participants from Facebook and online support groups and surveyed them about counseling experiences and psychosocial issues. We used multivariate linear regression to evaluate relationships between counseling quality and psychological outcomes.Results: We analyzed data from 145 respondents. Shared decision making and decision satisfaction scores were positively and strongly correlated in bivariate analysis (r=0.7, p<.0001), as were posttraumatic stress and grief scores (r=0.7, p<.0001). In the adjusted analysis, higher decision satisfaction was associated with lower grief and posttraumatic stress scores (p=.02 and p=.01, respectively) and higher shared decision making was associated with lower posttraumatic stress scores (p=.01).Conclusions: Decision satisfaction and shared decision making have a positive effect on psychological outcomes after second-trimester abortion for pregnancy complications. Counseling quality may be especially important in this setting given the sensitive nature of decisions regarding pregnancy termination for complications.Implication: These results highlight the importance of patient-centered counseling for women seeking pregnancy termination. [ABSTRACT FROM AUTHOR]

Objective: We sought to qualitatively understand patients' experiences with digoxin as a step before dilation and evacuation (D&E).Study Design: We recruited English-speaking women from one abortion health center where digoxin is routinely used before D&E. We interviewed participants one to three weeks after the D&E about physical and emotional experiences with digoxin and understanding of its purpose. Using grounded theory, we analyzed transcripts iteratively, identifying themes from interviews; we stopped recruitment when we reached thematic saturation.Results: We conducted 20 interviews and participants described mixed experiences. Three overarching themes from the qualitative interviews were: (1) physical and emotional discomfort; (2) varied understanding of digoxin's purpose and effects; and (3) reassurance. Most participants described significantly negative experiences with digoxin; however, many participants also described positive aspects of the injection intermingled with those negative experiences.Conclusions: Participants' experiences with digoxin before D&E were both polarized and nuanced. While participants were largely clear about digoxin's action, they were much less clear about the reason for its use.Implications: Both the clinical purpose for and patients' experiences with digoxin before D&E are complicated. Providers who continue to use digoxin should consider patient preferences in how they offer digoxin, and consider tools to ensure patient understanding. [ABSTRACT FROM AUTHOR]

Objectives: The literature has been conceptualizing pregnancy occurrence as a multiphase event. However, the different combinations of decisions and behaviors leading to pregnancy that end in abortion remain unexplored in the literature. The aims of the study were to describe the reproductive and relational trajectories leading to pregnancy in women who decide to abort and to explore the differences in this process according to women's age [adolescents (<20 years old) vs. adults].Study Design: In this cross-sectional study, 426 women [246 adolescents (58.4%), 177 adults (41.6%)] who chose abortion were recruited. Data on reproductive and relational characteristics were collected through a self-report questionnaire at 16 healthcare services that provide abortion. The variables were introduced in trajectories according to the criterion of temporal sequence between them: age at first sexual intercourse, relationship type, pregnancy planning, use of contraception, identification of contraceptive failure, and occurrence of pregnancy.Results: Seven trajectories leading to pregnancy were identified. The most frequent trajectory (30.8%) included women who 1) were involved in a long-term romantic relationship, 2) did not plan the pregnancy, 3) were using contraception, and 4) did not identify the contraceptive failure that led to pregnancy. Although this was the most frequent trajectory for both age groups, the remaining trajectories showed a different distribution. Compared to adolescents, adult women's trajectories more frequently included casual relationships with non-use of contraception, or contraceptive use with no contraceptive failure identification.Conclusion: Our study highlights the need to recognize the multiplicity of reproductive and relational trajectories leading to pregnancies that end in abortion and their specificities according to women's age. These findings have important implications for abortion counselling and for the development of age-appropriate guidelines for preventive interventions, by drawing attention to prioritization of different contexts of intervention according women's age. [ABSTRACT FROM AUTHOR]

Objective: To explore patient experiences of contraceptive coercion by healthcare providers at time of abortion.Study Design: We conducted a qualitative study of English-speaking women seeking abortion services at a hospital-based clinic. We used the Integrated Behavioral Model and the Reproductive Autonomy Scale to inform our semi-structured interview guide; the Scale provides a framework of reproductive coercion as a lack of autonomy or power to decide about and control decisions relating to reproduction. We enrolled participants until thematic saturation was achieved. Two coders used modified grounded theory to analyze transcribed interviews with Nvivo 11.0 (Κ=0.81).Results: The 31 women we interviewed from June 2016 to March 2017 were all in the first trimester, and predominantly young (mean age 27±5 years), non-Hispanic Black (52%) and Medicaid-insured (68%). Some participants (42%) reported feeling "pressured" into choosing some form of contraception. A subset of participants (26%) voiced that providers seemed to prefer LARC methods or were "pushing" a specific method. Several participants perceived pressure to choose any method due to providers' preference to prevent repeat abortions. Conversely, participants who were offered a range of methods through the use of decision aids and who were given time to deliberate demonstrated more reproductive autonomy.Conclusions: Almost half of participants perceived a form of coercion around their contraceptive counseling. Coercion manifested in perceived provider preference for specific methods or immediate initiation of a method. Participant narratives involving decision aids to offer a range of methods and time for deliberation demonstrated greater reproductive autonomy and less coercion. Abortion stigma may mediate potentially coercive interactions between patients and providers.Implications: This qualitative study explored contraceptive coercion at the time of abortion. Findings highlighted provider pressure to initiate contraception, LARC preference, and abortion stigma. Offering many methods and opportunity for deliberation supported autonomy and satisfaction. Findings inform ongoing efforts to improve contraceptive counseling and promote reproductive autonomy, while addressing unintended pregnancies. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to document the means women use to obtain abortions in the capital cities of Benin and Burkina Faso, and to learn whether or not use of misoprostol has become an alternative to other methods of abortion, and the implications for future practice.Study Design: We conducted in-depth, qualitative interviews between 2014 and 2015 with 34 women - 21 women in Cotonou (Benin) and 13 women in Ouagadougou (Burkina Faso) - about their pathways to abortion. To obtain a diverse sample in terms of socio-demographic characteristics, we recruited the women through our own knowledge networks, in health facilities where women are treated for unsafe abortion complications, and in schools in Benin.Results: The 34 women had had 69 abortions between them. Twenty-five of the women had had 37 abortions in the previous 5 years; the other abortions were 5-20 years before. Pathways to abortion were very different in the two cities. Lengthy and difficult pathways with unsafe methods often led to complications in Ougadougou, whereas most Cotonou women went to small, private health centers. Six of the 37 abortions in the previous 5 years involved misoprostol use, and were all among educated women with significant social and economic capital and personal contact with clinicians.Conclusions: Use of misoprostol for abortion has appeared in both Cotonou and Ougadougou in the past 5 years. Evidence that the use of misoprostol for abortion occurred among women with the most access to information and resources in this study suggests that increased awareness of and use of misoprostol in both countries is likely in the coming years.Implications: Although no pharmaceutical company that produces misoprostol has as yet tried to obtain marketing authorization in either Burkina Faso or Benin for gynecological-obstetric indications, making its use more potential than actual for the time being, international advocacy for access to medical abortion is growing rapidly and is likely to lead to many changes in this picture in the coming years. [ABSTRACT FROM AUTHOR]

The promise of medical abortion to both reduce maternal mortality and morbidity from unsafe abortion and to expand the reproductive rights of women can only be realized if information and reliable medicines are available to all women, regardless of their location or the restrictions of their legal system. Activist strategies to actualize the full potential of abortion pills are highlighted. [ABSTRACT FROM AUTHOR]

Objective: Legal restrictions on abortion access impact the safety and timing of abortion. Women affected by these laws face barriers to safe care that often result in abortion being delayed. Second-trimester abortion affects vulnerable groups of women disproportionately and is often more difficult to access. In Argentina, where abortion is legally restricted except in cases of rape or threat to the health of the woman, the Socorristas en Red, a feminist network, offers a model of accompaniment wherein they provide information and support to women seeking second-trimester abortions. This qualitative analysis aimed to understand Socorristas' experiences supporting women who have second-trimester medication abortion outside the formal health care system.Study Design: We conducted 2 focus groups with 16 Socorristas in total to understand experiences accompanying women having second-trimester medication abortion who were at 14-24 weeks' gestational age. We performed a thematic analysis of the data and present key themes in this article.Results: The Socorristas strived to ensure that women had the power of choice in every step of their abortion. These cases required more attention and logistical, legal and medical risks than first-trimester care. The Socorristas learned how to help women manage the possibility of these risks and were comfortable providing this support. They understood their work as activism through which they aim to destigmatize abortion and advocate against patriarchal systems denying the right to abortion.Conclusion: Socorrista groups have shown that they can provide supportive, women-centered accompaniment during second-trimester medication abortions outside the formal health care system in a setting where abortion access is legally restricted.Implications: Second-trimester self-use of medication abortion outside of the formal health system supported by feminist activist groups could provide an alternative model for second-trimester care worldwide. More research is needed to document the safety and effectiveness of this accompaniment service-provision model. [ABSTRACT FROM AUTHOR]

Objectives: To examine the treatment efficacy, safety and satisfaction of women using medical abortion (MA) pills provided by pharmacists following an education intervention based on a harm reduction approach.Study Design: This was an operations research study over a six-month period in 2015, using a non-inferiority design. We provided training to dispense MA pills, based on a harm reduction approach, to a group of pharmacy workers in Makwanpur district (GROUP 2). We compared selected outcomes with women who bought the pills from pharmacy workers in Chitwan district (GROUP 1), who had received similar training in 2010. The primary endpoint measured in 992 women in both districts was complete abortion within 30 days of using the pills. We assessed the efficacy of MA (self-reported complete abortion) and safety (no reported adverse event). To determine complete abortion, we asked women about passage of the products of conception, cessation of abdominal cramps, vaginal bleeding, need for manual vacuum aspiration or repeated doses of misoprostol. We used a four-point Lickert Scale to determine level of satisfaction with MA use. Pearson Chi-Square test was used to examine any differences in proportion of complete abortions between women who were served by the two groups of pharmacy workers.Results: The difference in the rate of complete abortions between the two groups of women, 96.9% and 98.8%, was not statistically significant. The women reported no serious complications, and there was little difference in their satisfaction levels.Conclusions: Trained pharmacy workers dispensed MA safely and effectively to the satisfaction of almost all women clients, and the positive results of training had continued several years later.Implications: The role of pharmacy workers as providers of correct and complete information on safe and effective use of MA needs to be recognized and policies formulated to allow them to provide MA drugs for first trimester use. [ABSTRACT FROM AUTHOR]

Introduction: The lack of economic development and longstanding conflict in Burma have led to mass population displacement. Unintended pregnancy and unsafe abortion are common and contribute to maternal death and disability. In 2011, stakeholders operating along the Thailand-Burma border established a community-based distribution program of misoprostol for early abortion, with the aim of providing safe and free abortion care in this low-resource and legally restricted setting.Methods: We conducted 16 in-depth, in-person interviews with women from Burma residing on both sides of the border who accessed misoprostol through the community-based distribution initiative. We analyzed interviews for content and themes using deductive and inductive methods.Results: Overall, women felt positively about their abortion experiences and the initiative. Previous abortion experiences and the recommendations of others shaped women's access. All participants, including those who remained pregnant after taking the misoprostol, would recommend the initiative to others.Conclusion: Community-based distribution of misoprostol is an effective and culturally appropriate method of improving safe abortion care on the Thailand-Burma border. Supporting efforts to expand the harm reduction program to more communities and provide regular reproductive health and safe abortion trainings appears warranted.Implications: In recent years, a number of organizations have launched programs dedicated to misoprostol-alone for early abortion. However, few have documented the experiences and perspectives of women. Our findings indicate providing misoprostol through lay provision in a legally restricted context is not only safe and effective but also culturally resonant. [ABSTRACT FROM AUTHOR]

Objective: To examine reasons for seeking abortion services outside the formal healthcare system in Great Britain, where abortion is legally available.Study Design: We conducted a mixed-methods study among women resident in England, Scotland, and Wales who requested at-home medication abortion through online telemedicine initiative Women on Web (WoW) between November 22, 2016, and March 22, 2017. We examined the demographics and circumstances of all women requesting early medication abortion and conducted a content analysis of a sample of their anonymized emails to the service to explore their reasons for seeking help.Results: Over a 4-month period, 519 women contacted WoW seeking medication abortion. These women were diverse with respect to age, parity, and circumstance. One hundred eighty women reported 209 reasons for seeking abortion outside the formal healthcare setting. Among all reasons, 49% were access barriers, including long waiting times, distance to clinic, work or childcare commitments, lack of eligibility for free NHS services, and prior negative experiences of abortion care; 30% were privacy concerns, including lack of confidentiality of services, perceived or experienced stigma, and preferring the privacy and comfort of using pills at home; and 18% were controlling circumstances, including partner violence and partner/family control.Conclusion: Despite the presence of abortion services in Great Britain, a diverse group of women still experiences logistical and personal barriers to accessing care through the formal healthcare system, or prefer the privacy of conducting their abortions in their own homes. Health services commissioning bodies could address existing barriers if supported by policy frameworks.Implications: The presence of multiple barriers to accessing abortion care in Great Britain highlights the need for future guidelines to recommend a more woman-centered approach to service provision. Reducing the number of clinic visits and designing services to meet the needs of those living in controlling circumstances are particularly important goals. [ABSTRACT FROM AUTHOR]

Objectives: To explore the ways in which medical abortion pills are obtained and used by university students in Chile in a clandestine context.Study Design: Using a qualitative approach, we conducted in-depth interviews with 30 young women who had had a medical abortion between 2006 and 2016 while attending university. We recorded the details of their pathways to abortion and their experience of abortion, and how they used networks in the university to find the pills and learn how to use them. The interviews were analyzed using narrative content analysis.Results: The findings show that medical abortion did not take place completely outside the healthcare system for these students, who accessed ultrasound scans pre- and post-abortion and post-abortion care. However, even with help and support from contacts, partners and friends, the clandestine situation created uncertainty and fear, which dominated the whole process, from finding and purchasing the pills, to uncertainty about correct doses and whether the abortion was going as it should and was complete or not. There was a high perception that failure and complications might be occurring, which led many of them to seek post-abortion care. The process was very demanding, requiring information, time, privacy to have the abortion, support and resources, and the ability to deal with risk.Conclusions: Medical abortion allowed these young women to have safe abortions in terms of reduced risks to health and autonomy through self-management. However, clandestinity made them physically, socially and emotionally vulnerable and exposed them to the risk of normative, violent judgments during post-abortion care.Implications: Access to medical abortion has transformed the experience of abortion in Chile, where abortion is illegal, because it is possible to use it safely and effectively outside healthcare settings. However, uncertainty, fear and risk will continue to dominate the experience, which can only be transformed by making abortion legal and available. [ABSTRACT FROM AUTHOR]

Objective: The objective was to learn what complications some women experienced in Madagascar following use of misoprostol for abortion and what treatment they received post misoprostol use.Study Design: This was a qualitative study in 2015-2016 among women who had experienced complications after use of misoprostol, with or without additional methods, for abortion; what information they received before use; what dosage and regimens they used; what complications they experienced; and what treatment they received postuse. We initially conducted in-depth, semistructured interviews with 60 women who had undergone an abortion that resulted in complications. The results presented here are based on interviews with the subset of 19 women who had used misoprostol.Results: The 19 women were aged 16-40, with an average age of 21-26 at interview and average age of 18-21 at abortion. To obtain an abortion, they sought advice from partners, friends, family members, and/or traditional practitioners and health care providers. Misoprostol was easily accessible through the formal and informal sectors, but the dosages and regimens the women used on the advice of others were extremely variable, did not match WHO guidelines and were apparently ineffective, resulting in failed abortion, incomplete abortion, heavy bleeding/hemorrhage, strong pain and/or infection.Conclusions: This study provides data on complications from the use of misoprostol as an abortifacient in Madagascar. Health care providers need training in correct misoprostol use and how to treat complications. Law and policy reforms are needed to support such training and to ensure the provision of safe abortion services in the public health system.Implications: Health care providers who provide abortion care and treatment of abortion complications need training in correct misoprostol use and treatment of complications. Women and pharmacy workers also need this information. Law and policy reforms are needed to allow training and provision of safe services. Further research is needed on the extent and impact of incorrect misoprostol administration. [ABSTRACT FROM AUTHOR]

Objectives We report on the development of a scale measuring abortion providers’ experiences of stigma. Study Design Using previous measures, qualitative data, and expert review, we created a 49-item question pool. We administered questions to 315 abortion providers before participation in the Providers Share Workshop. We explored the factor structure and item quality using exploratory factor analysis. We assessed reliability using Cronbach's alpha. To test construct validity, we calculated Pearson's correlation coefficients between the stigma scales, the Maslach Burnout Inventory, and the K10 measure of psychological distress. We used Stata SE/12.0 for analyses. Results Factor analysis revealed a 35-item, five-factor model: worries about disclosure, internalized states, social judgment, social isolation, and discrimination (Cronbach's alphas 0.79–0.94). Our stigma measure was correlated with psychological distress (r = 0.40; p < .001), and with Maslach Burnout Inventory's emotional exhaustion (r = 0.27; p < .001), and depersonalization (0.23; p < .001) subscales, and was inversely correlated with Maslach Burnout Inventory's personal accomplishment subscale (r = −0.15; p < .05). Conclusions Psychometric analysis of this scale reveals that it is a reliable and valid tool for measuring stigma in abortion providers, and may be helpful in evaluating stigma reduction programs. [ABSTRACT FROM AUTHOR]

Challenges unique to abortion care have negative implications for access to safe abortion and the psychosocial well-being of healthcare providers. A deeper understanding of the experience of providing abortion care can inform responsive interventions toward supporting abortion providers and strengthening health systems. A meta-ethnography was conducted to describe the experiences of providing abortion care and offer broad conceptual implications of abortion providers' experiences on their psychosocial coping and well-being. International grey and published research reported in English between 2000 and 2020 was identified via Web of Science Core Collection, PsycInfo, PubMed, Science Direct and Africa-Wide. Studies conducted in contexts where elective abortion is legally permitted were included. Study samples included nurses, physicians, counsellors, administrative staff and other healthcare providers involved in abortion care. Qualitative studies and qualitative data from mixed designs were included. The Critical Appraisal Skills Programme tool was used for appraisal and data was analysed using a meta-ethnographic approach. The review included 47 articles. Five themes arose from the data including the emotional challenges of providing clinical and psychological care, organisational and structural challenges, experiences characterised by stigma, pro-choice narratives, and coping with challenges. Outcomes ranged from moral and emotional alignment, resistance to abortion stigma, and job satisfaction to moral distress, emotional suppression, internalised stigma, selective participation and discontinuation of abortion care. Outcomes were dependent on the nature of interpersonal relationships, working conditions, the internalization of positive or negative messages about abortion, personal history and individual coping styles. Despite facing significant challenges in their work, the presence of positive outcomes among abortion providers and the moderating role of external and individual-level factors on well-being have encouraging implications for supporting psychosocial wellness among abortion providers. • Abortion providers face significant challenges related to anti-abortion stigma. • Psychosocial outcomes of abortion care varied among healthcare providers. • Internalization of positive constructions of abortion assisted with wellbeing. • Abortion providers benefitted from collegial support from one another. • Reflexivity and managing emotional investment and detachment improved outcomes. [ABSTRACT FROM AUTHOR]

Objective: Following the 2016US presidential election, social media posts and news stories amplified concerns about the potential for reduced access to contraception under the incoming administration and urged women to seek long-acting reversible contraception. We aimed to describe women's concerns about future access to contraception, in their own words.Study Design: A social-media-based, anonymous online survey assessing thoughts and concerns about future access to contraception was distributed to reproductive-aged US women for 1 week in mid-January 2017. Participants who were concerned about future access to contraception could share their thoughts and feelings in an open-ended comments box. We qualitatively analyzed 449 written responses for content and themes, with the goal of characterizing key concerns.Results: Women who provided written comments had a mean age of 28years; 85% were white, 88% had at least a college degree, and 93% identified as Democratic or Democratic-leaning. Women were highly concerned about future affordability of contraceptive methods due to potential loss of insurance, reduced insurance coverage for contraceptive methods and reduced access to low-cost care at Planned Parenthood. Many also worried about increased restrictions on abortion. Participants' concerns regarding access to contraception and abortion centered around themes of reproductive and bodily autonomy, which women described as fundamental rights.Conclusions: Women in this study expressed considerable fear and uncertainty regarding their future access to contraception and abortion following the 2016US presidential election. The potential for restricted access to affordable contraception and abortion was viewed as an unacceptable limitation on bodily autonomy.Implications: As the future of US health care policy is debated, many women are concerned about the impact of policy changes on their ability to access affordable contraception and abortion, which many view as essential to the preservation of bodily and reproductive autonomy. [ABSTRACT FROM AUTHOR]

What do women ending their pregnancies want and need to have a good clinical abortion experience? Since birth experiences are better studied, birth stories are more readily shared and many women who have had an abortion have also given birth, we sought to compare women's needs and preferences in abortion to those in birth. We conducted semi-structured intensive interviews with women who had both experiences in the United States and analyzed their intrapartum and abortion care narratives using grounded theory, identifying needs and preferences in abortion that were distinct from birth. Based on interviews with twenty women, three themes emerged: to be affirmed as moral decision-makers, to be able to determine their degree of awareness during the abortion, and to have care provided in a discreet manner to avoid being judged by others for having an abortion. These findings suggest that some women have distinctive emotional needs and preferences during abortion care, likely due to different circumstances and sociopolitical context of abortion. Tailoring services and responding to individual needs may contribute to a good abortion experience. [ABSTRACT FROM AUTHOR]

Objective: The objective was to investigate the effect of mandated abortion counseling requirements intended to dissuade women from having abortions on patients' individual-level abortion stigma.Methods: We randomized women presenting for abortion to complete a demographic survey and the validated Individual Level Abortion Stigma (ILAS) scale either before (unexposed) or after (exposed) hearing the mandatory Pennsylvania Abortion Control Act counseling via a standardized video. A sample size of 46 (23 per group) allowed us to detect a 1-standard-deviation difference in mean ILAS score between the groups. The ILAS scale ranges from 0 to 3.5, with higher scores indicating greater stigma.Results: From November 2015 to April 2016, 46 participants completed the study. All baseline characteristics were balanced except that the unexposed group had a greater proportion of low-income participants. The mean ILAS score among all participants was 1.02±0.60. ILAS scores were significantly higher among the unexposed group (median 1.25, interquartile range [IQR] 0.7-1.9) compared to the exposed group (median 0.75, IQR 0.5-1.05; p=.016). However, when controlling for participant income category, the effect of the mandated counseling on stigma scores was no longer present (p=.068).Conclusions: In this randomized trial, stigma scores were higher among women who had not heard the mandated abortion counseling when compared with stigma scores for those who had heard the script, but this effect was confounded by participants' income category.Implications: Despite the small sample size in this pilot study, differences in stigma scores for women exposed and unexposed to mandated counseling approached significance even after controlling for income category. Women who heard the mandated counseling had reduced stigma scores. A larger study is needed to better characterize this effect. Further research is needed to understand how state policies, counseling interactions and socioeconomic status are related to abortion stigma. [ABSTRACT FROM AUTHOR]

Background In 2013, Alabama required women seeking abortion to have a consultation visit followed by a 24-hour waiting period. These requirements may adversely affect return for timely care among those traveling long distances for services. Methods Using de-identified billing data from two Alabama clinics for all abortion encounters in 2013, we calculated the distance traveled from women's residential zip code and the number of days between their in-person consultation and procedure visits. To assess the associations between distance traveled and return for an abortion visit and length of interval between visits, we used logistic and ordinal logistic regression, respectively. Results Of the 2,730 women attending a consultation visit, 58% traveled less than 25 miles one way to the clinic, 13% traveled 25 to 49 miles, 21% traveled 50 to 100 miles, and 8% traveled more than 100 miles. Overall, 19% of women did not return to either clinic for an abortion procedure after their consultation. Distance traveled was not associated with return for an abortion visit (odds ratio, 1.04; 95% confidence interval, 0.76–1.42). Among women who returned, 59% had less than 7 days, 29% had 7 to 13 days, and 12% had 14 or more days between their consultation and procedure visits. Compared with women traveling less than 25 miles, those traveling 50 to 100 miles had significantly longer intervals between visits (odds ratio, 1.25; 95% confidence interval, 1.01–1.56). Conclusions Although most women returned for their abortion procedure, many traveling long distances had a week or more between visits. Because delays may limit women's options for affordable abortion care, evidence-based policies should be adopted to facilitate women's timely receipt of services. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the representation of abortion in contemporary hip-hop music, gaining insight into the myriad of attitudes of abortion in the black community.Study Design: We used Genius, an online storehouse for lyrical content, to identify songs by querying the database for search terms related to family planning, including slang terms. We then cross-referenced identified songs using an online list of songs about abortion. We analyzed eligible songs using grounded theory in order to identify key themes.Results: Of 6577 songs available, a total of 101 songs performed by 122 individual artists met inclusion criteria. The majority of artists were Black men; five artists were Black women. Key themes were: use of abortion as braggadocio; equating abortion with sin, genocide, or murder; male pressure for women to seek abortion; and the specific association of Planned Parenthood services with abortion.Conclusions: The moral and ethical themes surrounding abortion in hip-hop lyrics reveal a unique perspective within a marginalized community. The overall negative context of abortion in hip-hop lyrics needs to be reconciled with the gendered, economic, historical, political, racial and ethnic background of hip-hop and rap music in America.Implications: This study is the first to evaluate lyrical content from contemporary popular music in relation to abortion and family planning. Examining the intersection of reproductive rights and popular culture can provide a unique insight into the limited knowledge of the perspectives of abortion in the black community. [ABSTRACT FROM AUTHOR]

Drawing on qualitative data from a project on young women's experiences of abortion, this paper considers the dual exchange of the research interview. It considers the view that researcher and participant ‘collude’ in the research process to meet their individual and differing needs. The paper explores the researcher's active role in stimulating participants to talk about and disclose highly personal, and potentially stigmatising, experiences and interrogates the ways in which participants may use, or re-frame, research in a quasi-therapeutic capacity as a process of catharsis. This raises questions around whether the participant and researcher share common research goals, and the implications of this for informed consent. The paper concludes with a discussion of the problems of balancing the need of the researcher to ‘get the job done’ and to generate meaningful rich data, and the need to prioritise participant and researcher wellbeing throughout the research, suggesting that further consideration needs to be given to the post-consent process. [ABSTRACT FROM AUTHOR]

Contextual factors can shape public opinion towards abortion. We investigated the association between the state-level abortion legislative climate and individual attitudes towards abortion legality and government restrictions of abortion access in the United States. Data come from the 2020 Cooperative Congressional Election Study (n = 61,000). Using multivariable logistic regression with generalized estimating equations, we explored whether state-level abortion policy climates (based on the Guttmacher Institute's 2020 rating of state abortion policies) were associated with individual attitudes (1) towards abortion legality, and (2) towards government restriction of abortion access, controlling for individual socio-demographic factors. Eighty-eight percent of participants supported the legality of abortion in some or all circumstances. Conversely, 30% of the sample opposed all federal government restrictions on abortion. More than 60% of the sample lived in highly abortion-restrictive states. Participants living in states with a more supportive abortion legislative climate were more likely to support the legality of abortion in some or all circumstances (AOR = 1.07, (95% CI 1.05, 1.09). Participants in states with more supportive abortion policies were more likely to oppose federal governmental restrictions (AOR = 1.03, 95% CI 1.02, 1.04). Low religiosity, higher educational attainment, and politically liberal views were associated with increased support for abortion legality and increased opposition to government restrictions on abortion. State-level abortion policy contexts were positively associated with public attitudes towards abortion. While attitudes towards abortion legality are favorable across the country; there is also strong support at least one type of government restriction on abortion access. Results highlight a disconnect between multifaceted public attitudes towards abortion and polarized state contexts, suggesting that policymaking on abortion represents a higher level of polarization than exists at the individual level. Policymakers and legislators should more carefully consider the desires of the public when designing abortion legislation. • Support for legal abortion in some or all circumstances is high. • Support for no government restrictions on abortion access is lower. • Attitudes towards abortion legality and restrictions align with state legislation. • Individual attitudes towards abortion are less polarized than state legislation. • Policymakers must consider public opinion when crafting abortion legislation. [ABSTRACT FROM AUTHOR]

Abortion is common but highly stigmatized in the United States, and the overturning of Roe v. Wade severely restricted abortion access in many states across the nation. Data reveal that maternal morbidity and mortality are already increasing, and research suggests existing inequities in abortion access across racial/ethnic and socioeconomic groups will be exacerbated. Research has shown that social support (perceived and received aid from one's social network) and social capital (resources accessed through those social connections) can improve access to health services and decrease barriers to care. Given the escalating barriers to abortion, including longer travel distances, it is imperative to better understand the roles of social support and social capital within abortion access, especially for people living on lower incomes and people of color. Our team conducted in-depth interviews with post-abortion patients (n = 18) from an urban abortion clinic in Georgia in 2019 and 2020, shortly after a six-week gestational age abortion limit had been passed but before it was enacted. We examined how people described their social support and social capital – or lack thereof – when making decisions about their pregnancy and their ability to access abortion. We found that social support and social capital – economic support in particular – were key facilitators of both abortion access and parenting, but participants often experienced barriers to economic support within their social networks due to poverty, unstable partnerships, structural inequality, and abortion stigma. Women experienced constraints to their reproductive autonomy, wherein they had no alternatives but abortion. Our findings suggest that increased economic support and de-stigmatization of abortion are needed to improve reproductive autonomy. Our findings also indicate that restricting and outlawing abortion services is significantly detrimental to the well-being of pregnant people, their families and networks, and their communities by perpetuating cycles of poverty and deepening socioeconomic and racial/ethnic inequities. • Women experience many barriers to safe, legal abortion care in the United States. • Most participants perceived abortion as their only option for pregnancy resolution. • Community poverty & abortion stigma can limit access to social support & capital. • Social support and social capital can facilitate abortion access. • Restricting abortion access deepens socioeconomic and racial/ethnic disparities. [ABSTRACT FROM AUTHOR]

The ability to exercise full sexual and reproductive health and rights is shaped by the contextual environment, meaning that women and pregnant people must navigate patriarchal norms when seeking care. Despite growing evidence that men are able to influence pregnancy outcomes, there remains a paucity of research on how and why men are able to involve themselves in pregnancy and abortion decision-making. This study interrogates the mechanisms that drive men's involvement in pregnancies and abortions in James Town, Ghana. Data from a survey (n = 296) and in-depth interviews (n = 37) were collected between July 2020 and January 2021. The mixed-method analysis critically examined the relationship between men's support for a pregnancy or abortion and their constructions of masculinities. Findings framed sex and reproduction as both a facilitator and a threat to men's masculinity. Reproduction was an essential component of being a man. Men discussed the need to fulfil masculine ideals of being independent, provide financially, and be in an acceptable relationship in order to be 'ready' for fatherhood. However, men similarly operationalised the notion of 'readiness' as the driving force behind their involvement in abortion decision-making. As being a father without being ready could lead to social ostracism and derision, men discussed forcing their abortion desires onto their sexual partners and other pregnant people. Achieving masculine ideals, therefore, was a critical motivation for controlling women and pregnant people's bodies. Understanding the role of masculinities is critical in acknowledging the contextual and environmental factors that women and pregnant people navigate, which contribute to continued reproductive injustices. • Masculine norms are shaped by ideals of sex, reproduction, fatherhood, and providing. • Men develop norms around being 'ready' for fatherhood that determine their support for a pregnancy. • Men used abortions to facilitate ideals of manhood, rooted in 'readiness' for a live birth. • Abortion attitudes among men were not static and depending on the relationship to a person. • Masculinities contribute towards the conditions pregnant people have to navigate. [ABSTRACT FROM AUTHOR]

Background: Abortion has been legal without restriction in Canada since 1988 and is recognized as a medically necessary service. However, research indicates that women still face numerous barriers to accessing care, challenges that are amplified for women living in rural, remote and northern regions in Canada.Objectives: This qualitative study aimed to document women's experiences seeking and obtaining abortion services while residing in Yukon Territory, identify financial and personal costs and explore avenues through which services could be improved.Methods: We conducted 16 in-depth semi-structured phone interviews with women who accessed abortion services on/after January 1, 2005, while residing in the Yukon. We employed an iterative multiphase analytic approach centering on content and themes, using both inductive and deductive techniques.Results: With the Yukon's sole facility offering first trimester abortions twice a month, women experienced difficulty navigating a fragmented process and long wait times. Women found the process of attending multiple pre-procedure appointments at multiple locations with multiple health care providers, all while enduring pregnancy symptoms and handling other life commitments, physically, financially and emotionally taxing.Conclusion: Efforts to streamline the process of obtaining an abortion and providing women with more information at the first point of contact would improve service access and quality. Mifepristone has the potential to improve access for rural and remote populations, reduce wait times and alleviate privacy concerns, but only if the medication abortion regimen is affordable and available at a range of service delivery points and provision requirements are aligned with the global evidence.Implications: By documenting women's experiences, the identified barriers and outlined suggestions for improvement offer realistic avenues through which current abortion services in Yukon Territory can be modified in order to increase access. This study highlights future reproductive health care initiatives that warrant prioritization in Canada's North. [ABSTRACT FROM AUTHOR]

Objective: In Mexico, abortion stigma in the general population is largely unexplored. We developed a scale to measure abortion stigma at the community level, examine its prevalence and explore factors associated with abortion stigma in a nationally representative sample.Study Design: Following intensive qualitative work to identify dimensions of the stigma construct, we developed a comprehensive list of statements that were cognitively tested and reduced to 33 to form a scale. We piloted the scale in a nationally and subregionally representative household public opinion survey administered to 5600 Mexican residents.Results: Factor analysis tested the internal consistency and reliability of five previously hypothesized dimensions of abortion stigma: secrecy, religion, autonomy, discrimination and guilt/shame. Under the assumption that these dimensions were independent, confirmatory factor analysis indicated that each of these dimensions functioned as independent subscales. However, to test this assumption, we conducted exploratory factor analysis that revealed a strong codependence between discrimination, guilt/shame and religion statements, resulting in a 23-item four-factor model of abortion stigma and the elimination of the guilt/shame dimension. Both methods revealed a full scale and subscales with Cronbach's alphas between 0.80 and 0.90. Regression analyses suggested that older, less educated individuals living in the north of Mexico report higher levels of stigma, especially related to discrimination and religion.Conclusions: This community-level abortion stigma scale is the first to be developed and tested in Mexico. This tool may be used in Mexico and other similar country settings to document the prevalence of community-level abortion stigma, identify associated factors and test interventions aimed at reducing abortion stigma.Implications: Abortion stigma prevents women from accessing safe abortion services. Measuring community-level abortion stigma is key to documenting its pervasiveness, testing interventions aimed at reducing it and understanding associated factors. This scale may be useful in countries similar to Mexico to support policymakers, practitioners and advocates in upholding women's reproductive rights. [ABSTRACT FROM AUTHOR]

Background In Alabama, more than one-half of reproductive-aged women live in counties without an abortion provider. State regulations require in-person counseling (or confirmed receipt of materials sent by certified mail) followed by a 48-hour waiting period. We explored the impact of this service and policy environment on experiences accessing abortion care for women traveling long distances to clinics. Methods We conducted in-depth interviews with 25 women who traveled more than 30 miles to an Alabama clinic providing abortion care between July and September 2014. Women were interviewed by telephone at least 1 day after their consultation, procedure, or follow-up visit. We used content analysis methods to code and analyze interview transcripts. Findings Almost all women found a clinic by searching online or talking to others in their social networks who had abortions. These strategies did not always direct women to the closest clinic, and some described searches that yielded inaccurate information. The majority of women did not believe an in-person consultation visit was necessary and found it to be burdensome because of the extra travel required and long waits at the clinic. Two-thirds of the women were unable to schedule their abortion 48 hours later owing to work schedules or because appointments were offered only once a week, and four women were delayed until their second trimester even though they sought services earlier in pregnancy. Conclusions It is often difficult for women in communities without an abortion provider to find and access timely abortion care. Efforts are needed to make abortion more accessible and prevent further restrictions on services. [ABSTRACT FROM AUTHOR]

Objective: A wide spectrum of emotions are experienced during abortion, including anxiety, sadness and grief, guilt, pessimism about future pregnancies, disturbed self-perception and loss of confidence in intimate relationships. This study aimed to compare the short-term effects of legal voluntary termination of pregnancy with uterine evacuation for medical reasons on female sexual function.Study Design: The study group was comprised of 50 patients admitted to the Family Planning Clinic for legal voluntary termination of pregnancy <10 weeks of gestation, and the control group was comprised of 50 patients who underwent manual vacuum aspiration of the products of conception for medical reasons (e.g. inevitable abortion, incomplete abortion, fetal abnormality and teratogenic drug use). Female sexual function in the two groups was evaluated using the Golombok-Rust Inventory of Sexual Satisfaction (GRISS). GRISS scores immediately before and 3 months after termination of pregnancy were compared within each group and between the two groups.Results: Mean total GRISS scores before and after termination of pregnancy were 5.33 and 8.12 in the study group, and 6.02 and 6.4 in the control group, respectively (p<0.05). The increase in GRISS scores for both groups indicated deterioration in sexual function (p=0.000 and p=0.016, respectively). Three months after termination of pregnancy, the total GRISS score was significantly higher in the study group compared with the control group (8.12 vs 6.4, p<0.05).Conclusion: Female sexual dysfunction is a complicated concept that is affected by multiple factors over a woman's lifetime. It is important to consider female sexual function as a part of reproductive health, with a close relationship with contraception. As such, patients should receive counselling about sexual function and contraception as part of comprehensive abortion care. [ABSTRACT FROM AUTHOR]

Unsafe abortion is a significant but preventable cause of global maternal mortality and morbidity. Zambia has among the most liberal abortion laws in sub-Saharan Africa, however this alone does not guarantee access to safe abortion, and 30% of maternal mortality is attributable to unsafe procedures. Too little is known about the pathways women take to reach abortion services in such resource-poor settings, or what informs care-seeking behaviours, barriers and delays. In-depth qualitative interviews were conducted in 2013 with 112 women who accessed abortion-related care in a Lusaka tertiary government hospital at some point in their pathway. The sample included women seeking safe abortion and also those receiving hospital care following unsafe abortion. We identified a typology of three care-seeking trajectories that ended in the use of hospital services: clinical abortion induced in hospital; clinical abortion initiated elsewhere, with post-abortion care in hospital; and non-clinical abortion initiated elsewhere, with post-abortion care in hospital. Framework analyses of 70 transcripts showed that trajectories to a termination of an unwanted pregnancy can be complex and iterative. Individuals may navigate private and public formal healthcare systems and consult unqualified providers, often trying multiple strategies. We found four major influences on which trajectory a woman followed, as well as the complexity and timing of her trajectory: i) the advice of trusted others ii) perceptions of risk iii) delays in care-seeking and receipt of services and iv) economic cost. Even though abortion is legal in Zambia, girls and women still take significant risks to terminate unwanted pregnancies. Levels of awareness about the legality of abortion and its provision remain low even in urban Zambia, especially among adolescents. Unofficial payments required by some providers can be a major barrier to safe care. Timely access to safe abortion services depends on chance rather than informed exercise of entitlement. [ABSTRACT FROM AUTHOR]

Objective: To explore how doula support influences women's experiences with first-trimester surgical abortion.Study Design: We conducted semistructured interviews with women given the option to receive doula support during first-trimester surgical abortion in a clinic that uses local anesthesia and does not routinely allow support people to be present during procedures. Dimensions explored included (a) reasons women did or did not choose doula support; (b) key aspects of the doula interaction; and (c) future directions for doula support in abortion care. Interviews were transcribed, and computer-assisted content analysis was performed; salient themes are presented.Results: Thirty women were interviewed: 19 received and 11 did not receive doula support. Reasons to accept doula support included (a) wanting companionship during the procedure and (b) being concerned about the procedure. Reasons to decline doula support included (a) a sense of stoicism and desiring privacy or (b) not wanting to add emotion to this event. Women who received doula support universally reported positive experiences with the verbal and physical techniques used by doulas during the procedure, and most women who declined doula support subsequently regretted not having a doula. Many women endorsed additional roles for doulas in abortion care, including addressing informational and emotional needs before and after the procedure.Conclusion: Women receiving first-trimester surgical abortion in this setting value doula support at the time of the procedure. This intervention has the potential to be further developed to help women address pre- and postabortion informational and emotional needs.Implications: In a setting that does not allow family or friends to be present during the abortion procedure, women highly valued the presence of trained abortion doulas. This study speaks to the importance of providing support to women during abortion care. Developing a volunteer doula service is one approach to addressing this need, especially in clinics that otherwise do not permit support people in the procedure room or for women who do not have a support person and desire one. [ABSTRACT FROM AUTHOR]

Objective: Investigate which specific factors of abortion-related healthcare influence the overall satisfaction of women undergoing surgical abortion.Study Design: Between May and December 2014, we invited women undergoing first-trimester surgical abortion without sedation at six Northern California reproductive health clinics from two clinic systems (four clinics in System A and two clinics in System B) to complete an anonymous survey in the recovery room. The survey obtained demographic information and inquired about the women's level of satisfaction with different aspects of care (very satisfied, somewhat satisfied, not satisfied or dissatisfied, somewhat dissatisfied or very dissatisfied). The survey asked women to rank the three most important factors that contributed to their level of satisfaction. We analyzed the results using univariate and descriptive analyses to assess trends in responses related to level of satisfaction based on demographic and other variables.Results: A high percentage of women were very satisfied with their overall experience in both systems (A=79%, B=84%, p=0.34). Only 2% of women in System A and 1% in System B responded that they were neutral or not satisfied. The top three aspects of care ranked as most important were the same from both systems: ability to get an appointment in a timely manner, courtesy of staff and being informed as much as they wanted to know. Women were very satisfied or somewhat satisfied with these features of their care within both systems.Conclusion: Women are generally very satisfied by the first-trimester surgical abortion care they receive in different clinics. Although each clinic and system provides unique care, the factors contributing to women's level of satisfaction are consistent.Implications Statement: The most important factors that contribute to women's satisfaction with their first-trimester surgical abortion experience include the ability to get an appointment quickly, courtesy of the staff and being provided with information and responses to their questions. [ABSTRACT FROM AUTHOR]

Objective: To examine experiences of contraceptive care from the perspective of health professionals and women seeking abortion, in the contexts of hospital gynaecology departments and a specialist sexual and reproductive health centre (SRHC).Materials and Methods: We conducted in-depth semistructured interviews with 46 women who had received contraceptive care at the time of medical abortion (gestation ≤9weeks) from one SRHC and two hospital gynaecology-department-based abortion clinics in Scotland. We also interviewed 25 health professionals (nurses and doctors) involved in abortion and contraceptive care at the same research sites. We analysed interview data thematically using an approach informed by the Framework method, and comparison was made between the two clinical contexts.Results: Most women and health professionals felt that contraceptive counselling at abortion was acceptable and appropriate, if provided in a sensitive, nonjudgmental way. Participants framed contraceptive provision at abortion as significant primarily as a means of preventing subsequent unintended conceptions. Accounts of contraceptive decision making also presented tensions between the priorities of women and health professionals, around 'manoeuvring' women towards contraceptive uptake. Comparison between clinical contexts suggests that women's experiences may have been more positive in the SRHC setting.Conclusions: Whilst abortion may be a theoretically and practically convenient time to address contraception, it is by no means an easy time to do so and requires considerable effort and expertise to be managed effectively. Training for those providing contraceptive care at abortion should explicitly address potential conflicts between the priorities of health professionals and women seeking abortion.Implications: This paper offers unique insight into the detail of women and health professionals' experiences of addressing contraception at the time of medical abortion. The comparison between hospital and community SRHC contexts highlights best practise and areas for improvement relevant to a range of settings. [ABSTRACT FROM AUTHOR]

Rationale Most research in mental health and abortion has examined factors associated with post-abortion psychological health. However, research that follows women from before to after their abortion consistently finds that depressive, anxiety, and stress symptoms are highest just before an abortion compared to any time afterwards. Objective This finding suggests that studies investigating psychosocial factors related to pre-abortion mental health are warranted. Methods The current study uses data from 353 women seeking abortions at three community reproductive health clinics to examine predictors of pre-abortion psychological health. Drawing from three perspectives in the abortion and mental health literature, common risks, stress and coping, and sociocultural context, we conducted multivariable analyses to examine the contribution of important factors on depressive, anxiety, and stress symptoms just before an abortion, including sociodemographics, abortion characteristics, childhood adversities, recent adversities with an intimate partner, relationship context, future pregnancy desires, and perceived abortion stigma. Results Childhood and partner adversities, including reproductive coercion, were associated with negative mental health symptoms, as was perceived abortion stigma. Before perceived abortion stigma was entered into the model, 18.6%, 20.7%, and 16.8% of the variance in depressive, anxiety, and stress symptoms respectively, was explained. Perceived abortion stigma explained an additional 13.2%, 9.7%, and 10.7% of the variance in depressive, anxiety, and stress symptoms pre-abortion. Conclusion This study, one of the first to focus on pre-abortion mental health as an outcome, suggests that addressing stigma among women seeking abortions may significantly lower their psychological distress. [ABSTRACT FROM AUTHOR]

Background: Women who terminate pregnancies drink more subsequent to the pregnancy than women who give birth, including women who give birth after seeking to terminate a pregnancy.Methods: Data are from the Turnaway Study, a prospective, longitudinal study of 956 women who sought to terminate pregnancies at 30 U.S. facilities. This paper focuses on the 452 women who received terminations just below facility gestational limits and 231 who were denied terminations because they presented just beyond facility gestational limits. This study examined whether baseline characteristics moderate the relationship between termination and subsequent binge drinking and whether stress, feelings about the pregnancy, and number of social roles mediate the relationship.Results: Only having had a previous live birth modified the termination-binge drinking relationship. Among women with previous live births, binge drinking was reduced among women carrying to term compared to terminating the pregnancy. Among women who had not had a previous live birth, however, the reduction in binge drinking among those denied termination was not sustained over time, and binge drinking of those who had and had not had terminations converged by 2.5 years. Neither stress, negative emotions, nor social roles mediated effects on binge drinking. Positive emotions at one week mediated effects on binge drinking at six months, although positive emotions at two years did not mediate effects on binge drinking at 2.5 years.Conclusions: Higher levels of binge drinking among those who terminate pregnancies do not appear due to stress or to negative emotions. Only parous women - and not nulliparous women - denied terminations experienced sustained reductions in binge drinking over time. [ABSTRACT FROM AUTHOR]