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Objective: To evaluate safety, feasibility, and acceptability of a telemedicine medical abortion service without pre‐treatment in‐person tests in Ukraine, Uzbekistan, and Azerbaijan. Methods: We conducted an open‐label, prospective, observational clinical study at five clinics in the three countries. Interested and eligible participants scheduled a telemedicine consultation with a study provider by phone or video. Medical abortion pills could be obtained by mail or courier or picked up at the study clinic or a pharmacy. Study providers contacted participants 1 week after mifepristone ingestion to assess abortion outcomes based on symptoms, and 3 weeks later to review the result of an at‐home, high‐sensitivity, urine pregnancy test. Participants were referred to in‐person visit based on symptoms, urine pregnancy test results, or initiative by the participant. Results: In all, 300 women participated in the study. Almost all participants received medical abortion medications the same day as their first contact with the study clinic, and the majority (n = 297, 99.0%) did not experience any problems receiving them. All except two women (0.67%) followed provider instructions on administration of medications. The majority of participants had a complete abortion without a procedure (Ukraine: n = 115, 95.8%; Uzbekistan: n = 127, 97.7%; Azerbaijan: n = 49, 98.0%), few had in‐person visits (Ukraine: n = 30, 25.0%; Uzbekistan: n = 3, 2.3%; Azerbaijan: n = 4, 8.0%), and most were very satisfied or satisfied with the service (Ukraine: n = 116, 96%; Uzbekistan: n = 128, 98%; Azerbaijan: n = 45, 90%). No serious adverse events occurred. Conclusion: Telemedicine medical abortion using the no‐test protocol is safe, feasible and acceptable for women in Ukraine, Uzbekistan, and Azerbaijan. Synopsis: Telemedicine medical abortion using a no‐test protocol is safe, feasible, and highly acceptable to women in Ukraine, Uzbekistan, and Azerbaijan. [ABSTRACT FROM AUTHOR]

Background: The United Nations' Sustainable Development Goals identify universal access to sexual and reproductive health services as a global priority. Yet barriers to abortion access remain, including legal restrictions, cost, stigma, and limited services and information. The aim was to identify barriers to and facilitators of abortion care access experienced in Australia. Methods: This qualitative phenomenological study examined abortion access in Australia, where abortion is decriminalised, from March 2020 to December 2022. We used social media and flyers in clinics to recruit adults who had sought abortion care, then interviewed them in-depth. We mapped participant experiences to five dimensions of access identified by Levesque et al.'s patient-centred access to healthcare framework: approachability, acceptability, availability and accommodation, affordability, and appropriateness. Results: The 24 participants lived across Australia and sought abortion during the COVID-19 pandemic. Approachability: Before seeking abortion, most did not know where to access information about the service and where to obtain it. Acceptability: Many were uncomfortable disclosing their abortion to family or friends; they reported that healthcare providers demonstrated varying levels of support. Availability and accommodation: Regional participants travelled far and faced long wait-times, exacerbated by pandemic restrictions. Affordability: Participants described financial stress paying for the service, travel, and related expenses. Appropriateness: Most participants expected judgemental care. Experiences varied widely: many participants experienced unempathetic, rushed, or judgemental interactions with healthcare staff, and many also reported at least one non-judgmental and supportive interaction on the same pathway to care. Discussion: Abortion seekers experienced varying obstacles when seeking care. The findings illustrate the need for population- and system-level initiatives such as: providing accurate information about and normalising abortion; implementing system-level strategies to reduce wait times, travel, and costs, especially for rural populations; and developing regulatory and quality improvement initiatives to increase the workforce and its readiness to provide high-quality, non-judgemental abortion care. Challenges seeking care during pandemic restrictions illustrate the importance of social support during care and choice between abortion modalities and service types. Consumer voices can help understand the diverse pathways to abortion care and inform solutions to overcome the multidimensional barriers to access. [ABSTRACT FROM AUTHOR]

Many studies show that supranational governance structures (SGS)—understood as international organizations or international treaties—contribute to the global diffusion of public policies. However, we still have a limited understanding of which properties of SGS hasten the number of policy adoptions. To advance this literature, we argue that SGS making legally binding and univocal claims are more likely to act as diffusion accelerators. We demonstrate the suitability of this argument through a case study of the global diffusion of mifepristone approvals, a single‐purpose medicine to terminate pregnancies that has revolutionized abortion services. The analysis supports our expectation. Links to the EU and the Maputo Protocol—the only two considered SGS that make binding claims with clear implications for this policy field—hasten mifepristone approvals. By contrast, ratification of four other treaties—that do not make binding and univocal claims—and exposure to World Health Organization guidelines on medical abortion does not hasten these approvals. [ABSTRACT FROM AUTHOR]

AbstractApproximately 753 million women (38%) of reproductive age live in countries with restrictive abortion laws. To overcome these legal constraints, women access safe self-managed medication abortions through telemedicine abortion services. This study aimed to explore the long-term impact of accessing a self-managed medication abortion through telemedicine service on women’s lives in countries with restrictive abortion laws. We conducted interviews with eleven women (from eleven different countries) who accessed a self-managed medication abortion through online telemedicine between 2014 and 2018 in a legally restricted country. We analysed interviews thematically. Three key themes were developed: (1) access to abortion positively impacted life plans; (2) the negative influence of the legally restricted environment wore off and their well-being improved; (3) participants are now using their own experiences to help others by either sharing information or facilitating access to abortion. In summary, our findings highlight the positive impact of access to self-managed medication abortion and underline the importance of ensuring access to abortion for everyone. [ABSTRACT FROM AUTHOR]

Background: In sub-Saharan Africa, the number of maternal deaths due to unsafe abortions has been gradually rising. In Ethiopia, unplanned pregnancies contribute to 25% of births, accounting for 6%–9% of the maternal deaths resulting from unsafe abortions. Despite several disjointed cross-sectional studies that have been carried out in the past, there is no comprehensive data on the attitudes of healthcare practitioners and other related aspects regarding safe abortion in Ethiopia. This study attempted to measure pooled health care providers' attitudes and determinants of safe abortion in Ethiopia. Methods: African Journals Online, Medline/PubMed, EMBASE, Science Direct, Hinari, and Google Scholar were the databases that were accessed. The studies were evaluated critically by using the Joanna Briggs Critical Appraisal methods. The study followed the recommendations set forth by Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). Data were extracted in an Excel spreadsheet and imported to STATA versions 17 software for meta-analysis. The random- effects model was used to pooled the health care providers' attitudes toward safe abortion. Heterogeneity between studies was evaluated using the Cochrane Q-test and I2 statistics (I squared statistics). To evaluate publication bias, egger's tests and funnel plots were employed. Forest plot was used to present the odds ratio (OR) with a 95% confidence interval. Results: In this review and meta-analysis, a total of eight papers with a 2,826 sample size were considered. Overall, 65.49% of Ethiopian health care professionals had a positive attitude towards safe abortion (95%CI: 49.64, 81.34; I2 = 99.20%, P = 0.000). Knowledge of the abortion law (OR = 2.25, 95% CI: 1.06, 3.43), being a male provider (OR = 1.89, 95% CI: 1.23, 2.54), receiving training on abortion (OR = 2.91, 95% CI: 1.17, 4.65), working as a midwife (OR = 3.029, 95% CI: 1.605, 4.453) and practicing abortion procedures (OR = 2.55, 95% CI: 1.32, 3.78) were positively associated with the attitudes of the providers regarding safe abortion in Ethiopia. Conclusion: In Ethiopia, there was a low pooled prevalence of positive attitude towards safe abortion. Safe abortion services in Ethiopia are more likely to be viewed favorably by health care professionals who have received abortion service training and are familiar with abortion laws. As a result, it is imperative that all healthcare facilities and other relevant parties ensure that health professionals receive training on safe abortion services and are aware of Ethiopia's abortion laws. [ABSTRACT FROM AUTHOR]

Abortion is significantly restricted by law in most Pacific Island countries, impacting the rights, health and autonomy of people who experience pregnancy. We undertook qualitative research between February and August 2022 on Rarotonga, Cook Islands, where abortion is illegal under most circumstances. We conducted interviews with women who had accessed or tried to access abortion services; people who had supported women to access abortion services; health workers; and advocates to understand their experiences regarding abortion. We conducted focus groups to explore broader social perceptions and experiences of sexual and reproductive health and rights, including abortion. Participants described their abortion decisions and methods, and their negotiation of the personal context of their sexual behaviours, pregnancies, and abortions relative to their socio-cultural context and values. As defined by the World Health Organization, safe abortion relates to the methods and equipment used and the skills of the abortion provider. We argue for an expansion of this definition to consider inclusion of reference to individuals' 'abortion safety nets' as the sum of their access to financial, political, health care and socio-cultural resources. These safety nets are shaped by discourses related to abortion and socio-cultural support and values, impacting physical, emotional, psychological, social and spiritual health. [ABSTRACT FROM AUTHOR]

This study examines abortion-related discourse on Twitter (X) pre-and post-Dobbs v. Jackson ruling, which eliminated the constitutional right to abortion. We used a custom data collection tool to collect tweets directly from Twitter using abortion-related keywords. We used the BERTopic language model and examined the top 30 retweeted and top 30 textually similar tweets from relevant topic clusters using an inductive coding approach. We also conducted statistical testing to assess potential associations between abortion themes. 166,799 unique tweets were collected from December 2020-December 2022. 464 unique tweets were coded for abortion-related themes with 154 identified as relevant. Of these, 66 tweets marketed abortion pills, 17 tweets were identified as offering consultations, and 91 tweets were relevant to self-managed abortion. All marketing and consultation tweets were posted post-Dobbs decision and 7 (7.69%) of self-managed tweets were posted pre-Dobbs versus 84 (92.30%) posted post-Dobbs. A positive association was found between tweets offering a medical consultation with tweets marketing abortion pills and discussing self-managed abortion. This study detected online marketing of abortion pills, consultations and discussions about self-managed abortion following the Dobbs v. Jackson ruling. These results provide more context to the type of abortion-related information that is available online. This study examined tweets occurring both pre and post Dobbs decision and identified relevant discussions about self-managed abortion services, marketing and sale of abortion pills, and offering purported medical consultations. These findings indicate that abortion-related tweets, particularly those marketing abortion medications, increased after the Dobbs v. Jackson ruling. These findings highlight the evolving abortion information environment in the United States on Twitter, which represents a platform where health and politicised issues are commonly discussed. [ABSTRACT FROM AUTHOR]

A questionnaire-based study was jointly organised by European Board and College of Obstetrics and Gynaecology and European Society of Contraception to evaluate the current status as regards access and quality of care regarding contraception, abortion care, and pre-conceptional counselling and care among the 26 European countries. There are considerable variations among these countries as regards the provision of contraceptive services and abortion care. There is ample room for improvement through European training and education programs. However, the most important difference is the absence of a comprehensive network of healthcare providers in various countries to deliver these services at different points of access. There is notable absence of educational programs and instructional materials tailored specifically for nurses and midwives in several countries. This deficiency impedes the professional development and skills enhancement of these healthcare professionals, potentially compromising the quality of healthcare services provided to women in these countries. [ABSTRACT FROM AUTHOR]

AbstractIncarcerated women are confined in institutions designed to punish. These sites often ignore the complex mental and physical health needs of people who are incarcerated. Despite the World Health Organization stressing the need for access to reproductive healthcare in carceral institutions, stigma surrounding abortion care and health inequalities create contextually specific issues for incarcerated people seeking to access these services. There is also a dearth of research conducted directly with incarcerated women, trans men and non-binary people to examine their experiences of abortion. A systematic review of international peer-reviewed and grey literature was completed to summarise existing evidence from research conducted on the experiences of needing abortion care whilst incarcerated. Various experiences were identified including: conditions of confinement shaping abortion decisions; bureaucratic obstacles to accessing abortion services; incarcerated women, carceral staff and carceral healthcare staff’s lack of understanding of abortion rights and procedures; and a scarcity of support and empathy, including experiences of stigmatisation and lack of confidentiality. There exists a significant gap in research examining the experiences of incarcerated people who may need an abortion, emphasising the need for international collaboration and advocacy to address systemic issues that extend beyond local contexts. [ABSTRACT FROM AUTHOR]

Objectives Methods Results Conclusion Describe the characteristics and changes in the profile of women who sought care after experiencing sexual violence (SV) during the first six months of the COVID‐19 pandemic in a Brazilian city.This is a cross‐sectional retrospective study. Data from emergency care and legal abortion requests of women assisted at the Women's Health Care Center Hospital (School of Medical Sciences, University of Campinas, Brazil) due to SV experienced between March 23 and August 23, 2020 (Quarantine Group, QG), were collected and compared with data from the same period of the previous biennium (Comparison Group, CG). χ2 and Fisher's exact tests were used to compare groups; the significance level was 5%.Data for 236 women were analyzed; 70 women were included in the QG and 166 in the CG. In the QG, there was a restriction in the area of origin of women, with a higher proportion of women who lived in Campinas (P = 0.0007) and a higher frequency of chronic SV (P = 0,035). There were no rapes associated with the use of social media or apps in the QG, but 9.8% of women in the CG experienced rape associated with the use of social media or apps. There were higher rates of domestic violence (P = 0.022) and intimidation through physical force (P = 0.011) in the first two months.The COVID‐19 quarantine affected the profile of women who sought care after experiencing SV. The quarantine resulted in changes in the area of origin of patients, hindering access to health services and leading to higher rates of chronic and domestic SV, particularly in the first 2 months of the pandemic. [ABSTRACT FROM AUTHOR]

Background: Despite attempts to increase Universal Health Coverage, availability, accessibility, acceptability, and quality-related challenges remain barriers to receiving essential services by women who need them. We aimed to explore the experiences and perceptions of women receiving post-abortal care services in Zambia, within a human-rights framework. Methods: A qualitative case study was conducted between August and September 2021 in Lusaka and Copperbelt provinces of Zambia. Fifteen (15) women seeking post-abortion care services were' interviewed using audio recorders; transcribed data was analyzed using thematic analysis. We report women's experiences and perceptions of the healthcare system, their experiences of abortion, and healthcare-seeking behaviour. We used the availability, accessibility, acceptability, and quality (AAAQ) framework to understand how women claimed their right to healthcare as they sought and utilized post-abortion care services. Results: Women who experienced spontaneous abortions delayed seeking health care by viewing symptoms as 'normal pregnancy symptoms' and not dangerous. Women also delayed seeking care because they feared the negative attitudes from their communities and the health care providers towards abortion in general, despite it being legal in Zambia. Some services were considered costly, impeding their right to access quality care. Conclusions: Women delayed seeking care compounded by fear of negative attitudes from the community and healthcare providers. To ensure the provision and utilization of quality all abortion-related healthcare services, there is a need to increase awareness of the availability and legality of safe abortion services, the importance of seeking healthcare early for any abortion-related discomfort, and the provision and availability of free services at all levels of care should be emphasized. Plain language summary: Unsafe abortions continue to be an avoidable public health concern both globally and locally. In Zambia, a fifth of maternal deaths are related to unsafe abortions. Unsafe abortions have been defined as any induced termination of pregnancy outside the health facility, performed by untrained health personnel. Several strides have been made including the provision of comprehensive abortion care in all facilities, and the training of health personnel to provide these services at different levels of healthcare. Despite the increased availability of comprehensive abortion care through liberalized abortion laws and regulations and the training of health personnel to provide these services at different levels of healthcare, the need for quality post-abortion care specifically persists. As such, we carried out in-depth interviews to explore the experiences of women who present at healthcare facilities in Lusaka and the Copperbelt provinces in Zambia seeking post-abortion services. It was found that delay in seeking care at a health facility was due to fear that the service is illegal; alongside judgment from health care providers and society for seeking such a service that is generally perceived as evil. The assumption that the cost of receiving such services is high and a general lack of awareness about the service being provided free was also expressed. The study highlighted the need for community awareness of the legal framework on abortions to ensure women access services at any time necessary without fear of being judged, which will consequently reduce the number of abortion-related disabilities and deaths. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Discussion Financial costs remain one of the greatest barriers to abortion, leading to delays in care and preventing some from getting a desired abortion. Medication abortion is available through in‐person facilities and telehealth services. However, whether telehealth offers a more affordable option has not been well‐documented.We used Advancing New Standards in Reproductive Health (ANSIRH)'s Abortion Facility Database, which includes data on all publicly advertising abortion facilities and is updated annually. We describe facility out‐of‐pocket prices for medication abortion in 2021, 2022, and 2023, comparing in‐person and telehealth provided by brick‐and‐mortar and virtual clinics, and by whether states allowed Medicaid coverage for abortion.The national median price for medication abortion remained consistent at $568 in 2021 and $563 in 2023. However, medications provided by virtual clinics were notably lower in price than in‐person care and this difference widened over time. The median cost of a medication abortion offered in‐person increased from $580 in 2021 to $600 by 2023, while the median price of a medication abortion offered by virtual clinics decreased from $239 in 2021 to $150 in 2023. Among virtual clinics, few (7%) accepted Medicaid. Median prices in states that accept Medicaid were generally higher than in states that did not.Medication abortion is offered at substantially lower prices by virtual clinics. However, not being able to use Medicaid or other insurance may make telehealth cost‐prohibitive for some people, even if prices are lower. Additionally, many states do not allow telehealth for abortion, deepening inequities in healthcare. [ABSTRACT FROM AUTHOR]

Aim Design Methods Results Conclusion Implications for the Profession and/or Patient Care Impact Reporting Method Patient or Public Contribution To describe key features of a co‐designed nurse‐led model of care intended to improve access to early medication abortion and long‐acting reversible contraception in rural Australian general practice.Co‐design methodology informed by the Experience‐Based Co‐Design Framework.Consumers, nurses, physicians and key women's health stakeholders participated in a co‐design workshop focused on the patient journey in seeking contraception or abortion care. Data generated at the workshop were analysed using Braun and Clarkes' six‐step process for thematic analysis.Fifty‐two participants took part in the co‐design workshop. Key recommendations regarding setting up the model included: raising awareness of the early medication abortion and contraceptive implant services, providing flexible booking options, ensuring appointment availability, providing training for reception staff and fostering good relationships with relevant local services. Recommendations for implementing the model were also identified, including the provision of accessible information, patient‐approved communication processes that ensure privacy and safety, establishing roles and responsibilities, supporting consumer autonomy and having clear pathways for referrals and complications.Our approach to experience‐based co‐design ensured that consumer experiences, values and priorities, together with practitioner insights, were central to the development of a nurse‐led model of care.The co‐designed nurse‐led model of care for contraception and medication abortion is one strategy to increase access to these essential reproductive health services, particularly in rural areas, while providing an opportunity for nurses to work to their full scope of practice.Nurse‐led care has gained global recognition as an effective strategy to promote equitable access to sexual and reproductive healthcare. Still, nurse‐led contraception and abortion have yet to be implemented andevaluated in Australian general practice. This study will inform the model of care to be implemented and evaluated as part of the ORIENT trial to be completed in 2025.Reported in line with the Standards for Reporting Qualitative Research (SRQR) checklist.Two consumer representatives contributed to the development of the co‐design methodology as members of the ORIENT Intervention Advisory Group Governance Committee. [ABSTRACT FROM AUTHOR]

Although the work of health care providers in delivering care for their patients and communities has always been impacted by legislative changes, reproductive health care services, especially abortion care, has received more scrutiny, undergone disparate and excessive attempts at overregulation, and has been subject to more restrictions than most fields of medicine. The June 2022 Supreme Court decision in Dobbs v. Jackson Women's Health Organization, essentially overturning the federal constitutional protections of the legal right to access abortion afforded by the Roe v. Wade decision in 1973, has brought this issue to the forefront for many clinicians across sectors and disciplines. As trusted voices, physicians and other health care providers are uniquely positioned to discuss the implications of policies that restrict access to comprehensive reproductive health care, including abortion services, as they bear witness to the challenges this creates for them in practice and the communities they care for. This article discusses the impact of the Dobbs ruling on medical providers and their patients as well as the responsibility of health care providers to advocate for abortion access. [ABSTRACT FROM AUTHOR]

Background Aim Method Results Conclusion The barriers to comprehensive abortion care in Australian metropolitan tertiary hospitals are under‐researched. Previous work has suggested that negative practitioner attitudes and lack of training may play a large role; however, this remains poorly understood.The aim was to survey doctors practicing obstetrics and gynaecology to better understand their views, training experience and confidence in abortion care.The method involved a cross‐sectional study via an anonymous survey at a single metropolitan tertiary hospital not providing substantive abortion services in Melbourne, Australia. Inclusion criterion was obstetric and gynaecology medical staff working at that hospital. Data were collected regarding views, training experiences and confidence in first‐trimester medical and surgical abortion, and second‐trimester surgical abortion. Data were analysed according to levels of training, categorised as RANZCOG (Royal Australian and New Zealand College of Obstetricians and Gynaecologists) Fellows, prevocational/vocational trainees and general practitioner specialists.Sixty‐one valid responses were received from 90 eligible participants (response rate 68%). An overwhelming majority (96%) supported abortion services. The majority of RANZCOG Fellows felt confident performing first‐trimester surgical abortion (89%) and first‐trimester medical abortion (71%); however, only half felt confident performing second‐trimester surgical abortion (50%). Prevocational/vocational trainees were overall less confident but overwhelmingly expressed interest in gaining further experience in abortion.Doctors are generally confident in providing first‐trimester abortion services (medical or surgical) in the metropolitan tertiary setting. However, further work is required to understand ongoing barriers to comprehensive abortion care. There may also be a skills shortage for second‐trimester surgical abortion, requiring significant improvements in abortion training. [ABSTRACT FROM AUTHOR]

The Dobbs v Jackson Women's Health Organization Supreme Court decision, which revoked the constitutional right to abortion in the USA, has impacted the national medical workforce. Impacts vary across states, but providers in states with restrictive abortion laws now must contend with evolving legal and ethical challenges that have the potential to affect workforce safety, mental health, education, and training opportunities, in addition to having serious impacts on patient health and far-reaching societal consequences. Moreover, Dobbs has consequences on almost every facet of the medical workforce, including on physicians, nurses, pharmacists, and others who work within the health-care system. Comprehensive research is urgently needed to understand the wide-ranging implications of Dobbs on the medical workforce, including legal, ethical, clinical, and psychological dimensions, to inform evidence-based policies and standards of care in abortion-restrictive settings. Lessons from the USA might also have global relevance for countries facing similar restrictions on reproductive care. [ABSTRACT FROM AUTHOR]

On June 24, 2022, the US Supreme Court's decision in Dobbs v Jackson Women's Health Organization marked the removal of the constitutional right to abortion in the USA, introducing a complex ethical and legal landscape for patients and providers. This shift has had immediate health and equity repercussions, but it is also crucial to examine the broader impacts on states, health-care systems, and society as a whole. Restrictions on abortion access extend beyond immediate reproductive care concerns, necessitating a comprehensive understanding of the ruling's consequences across micro and macro levels. To mitigate potential harm, it is imperative to establish a research agenda that informs policy making and ensures effective long-term monitoring and reporting, addressing both immediate and future impacts. [ABSTRACT FROM AUTHOR]

Objectives Methods Results Conclusions Philanthropic abortion funds are integral to accessing care in the United States, providing both financial and practical assistance. Yet relatively little is known about those who seek these essential services. In this study, we analyzed data from a Kentucky abortion fund to assess characteristics of abortion fund callers.We analyzed 2014–2021 administrative data from the Kentucky Health Justice Network's (KHJN) Abortion Support Fund and compared them to abortion data from the Kentucky Department for Public Health (KDPH). We analyzed age, race, and pregnancy gestation at calling (KHJN) and abortion (KDPH), and calculated Z‐scores and p‐values to compare proportions in each category between the two data sources.The fund supported 6162 people from 2014 to 2021, when 28,741 people had abortions in Kentucky. Compared with KDPH data, KHJN had a higher percentage of callers who were under age 30, a higher percentage of callers who were Black or another race, and a higher percentage of callers at 14 weeks' gestation or higher.Compared with state data, KHJN supported a higher percentage of young people, people of color, and people at later gestations. These findings support evidence that structurally vulnerable groups are more likely to face barriers to care and that abortion funds provide essential support necessary for reproductive equity. [ABSTRACT FROM AUTHOR]

AbstractUnsafe abortions contribute significantly to maternal mortality and morbidity in Ghana. To reduce this, in 1982 abortion laws in Ghana underwent reform to broaden the conditions under which abortion is accessed. Although, evidence in other contexts highlights the contribution of violence to women’s experience of unwanted pregnancy and abortion, such evidence is limited within the Ghanaian abortion literature. This study aims to fill that gap. Informed by phenomenology, interviews were conducted with 10 women who had experienced various forms of violence leading to unwanted pregnancy and unsafe abortions. Participants were recruited between June 2017 and March 2018 in the Ashanti region of Ghana where they sought hospital care for unsafe abortion related complications. Participants mentioned intimate partners as the main perpetrators of violence. Financial challenges were also identified as important in increasing women’s vulnerability to violence. Verbal abuse from health workers contributed to denying women access to safe abortion. This paper advances dialogue about the ways in which women’s experience of violence from intimate/non-intimate partners and healthcare workers impacts their overall abortion experience. It advocates the empowerment of women to enable them to leave violent relationships, and the retraining of health workers to enable them to adopt respectful and empathetic care practices. [ABSTRACT FROM AUTHOR]

The article focuses on the legal implications of state travel bans for minors seeking abortions and the necessity of protecting their right to travel. Topics include the fundamental rights of minors; the application of strict scrutiny to travel restrictions; the constitutional basis for the right to interstate travel; and calls for judicial intervention to ensure that pregnant minors can access abortion services in neighboring states without legal hindrance.

In 2022, the U.S. Supreme Court overruled Roe v. Wade, ushering in a new era for abortion regulation. In some states, like Wisconsin, abortion was instantly re-criminalized. In rare but serious instances, health care providers faced the dilemma of deciding whether to delay care for emergency abortion services to save the life of a mother, for fear of criminal prosecution. As a result, some providers wondered if their professional liability insurance plan would provide a legal defense in the event ofa criminal charge ofillegally performing an abortion, though the facts may show it was to save the life of a mother. This Comment explores how professional liability insurance coverage is a solution to prevent providers from delaying care. Specifically, this Comment explains the current legal landscape of abortion in the state of Wisconsin and across the country, and explains how criminal acts exclusions in professional liability plans impact coverage. Next, this Comment discusses how plans may be construed through common law principles to find insurance coverage for providers, and thus provide them with a legal defense. After this explanation, this Comment describes how states, such as Wisconsin, have historically attempted to prevent defensive medicine and would thus also be served by my suggested solution. Lastly, this Comment considers remaining barriers to finding coverage for providers. [ABSTRACT FROM AUTHOR]

The past decade has seen a burgeoning of scholarly interest in conscientious objection in healthcare. While the literature to date has focused primarily on individual healthcare practitioners who object to participation in morally controversial procedures, in this article we consider a different albeit related issue, namely, whether publicly funded healthcare institutions should be required to provide morally controversial services such as abortions, emergency contraception, voluntary sterilizations, and voluntary euthanasia. Substantive debates about institutional responsibility have remained largely at the level of first-order ethical debate over medical practices which institutions have refused to offer; in this article, we argue that more fundamental questions about the metaphysics of institutions provide a neglected avenue for understanding the basis of institutional conscientious objection. To do so, we articulate a metaphysical model of institutional conscience, and consider three well-known arguments for undermining institutional conscientious objection in light of this model. We show how our metaphysical analysis of institutions creates difficulties for justifying sanctions on institutions that conscientiously object. Thus, we argue, questions about the metaphysics of institutions are deserving of serious attention from both critics and defenders of institutional conscientious objection. [ABSTRACT FROM AUTHOR]

Background The 2022 Supreme Court ruling in Dobbs v Jackson Women's Health Organization nullified the constitutional right to abortion, which led to effective bans in at least 14 US states and placed obstetrics and gynecology (OB/GYN) residents in dilemmas where they may have to withhold care, potentially causing moral distress—a health care workforce phenomenon less understood among resident physicians. Objective To identify and explore moral distress experienced by OB/GYN residents due to care restrictions post-Dobbs. Methods In 2023, we invited OB/GYN residents, identified by their program directors, training in states with restricted abortion access, to participate in one-on-one, semi-structured interviews via Zoom about their experiences caring for patients post-Dobbs. We used thematic analysis to analyze interview data. Results Twenty-one residents described their experiences of moral distress due to restrictions. We report on 3 themes in their accounts related to moral distress (and 4 subthemes): (1) challenges to their physician identity (inability to do the job, internalized distress, and reconsidering career choices); (2) participating in care that exacerbates inequities (and erodes patient trust); and (3) determination to advocate for and provide abortion care in the future. Conclusions OB/GYN residents grappled with moral distress and identified challenges from abortion restrictions. [ABSTRACT FROM AUTHOR]

Objective: To determine whether clinical outcomes among clients undergoing medical abortion after 12 weeks' gestation differ by provider cadre. Methods: Randomized controlled trial conducted among eligible clients seeking abortion between 13 and 20 weeks' gestation. Participants seeking in‐facility abortion were randomized to receive care from a mid‐level provider (nurse/midwife) or physician. The primary outcome was median time to expulsion with non‐inferiority margin of −1.5 h between provider groups. Quantile median regression models assessed non‐inferiority. Secondary outcomes included retained placenta, complications, and patient acceptability. Results: After randomization and eligibility assessment by the provider, 171 women participated in the study: 81 in the physician group and 90 in the mid‐level provider group. Their average age was 24 years, the mean gestational age was 16 weeks, and 65% were nulliparous in both groups. The median time to expulsion did not differ significantly, being 8.1 h for the mid‐level group and 6.6 h for the physician group. The adjusted median difference was 0.8 h (95% confidence interval [CI] –1.15 to 2.66), within the non‐inferiority margin. Retained placenta occurred similarly: 30.0% (n = 24) of the physician group and 20.5% (n = 18) of the mid‐level provider group (adjusted risk difference [ARD] 7.6%, 95% CI –2.81 to 18.06). Complications occurred in 7% of cases, including 5.0% (n = 4) of patients in the physician group and 8.9% (n = 8) in the mid‐level provider group (ARD –4.7%, 95% CI –12.43 to 3.12). Patient acceptability did not differ by group. Conclusions: Training mid‐level providers to provide abortion services after 12 weeks' gestation independently of physicians is feasible and may result in comparable clinical outcomes. Synopsis: Training mid‐level providers in abortion service provision after 12 weeks' gestation is feasible and results in comparable patient clinical outcomes to those achieved by physician‐led care. [ABSTRACT FROM AUTHOR]

Objective: To evaluate requests for legal abortion due to pregnancies resulting from sexual violence (SV) in a reference service, and characterise and compare the outcome groups. Retrospective cohort study with review of medical records of women assisted between 2015 and 2020. The variables were socio-demographic and SV characteristics, gestational age, reactions towards pregnancy and outcome. We compared outcome groups using the chi-square test, Fisher's exact test and the Kruskal–Wallis test. The significance level was 5%. We evaluated the medical records of 235 women, of which 153(65%) had undergone to abortion; 17(7.2%) had a spontaneous abortion; 19(8%) remained pregnant; 25(10.6%) had an abortion denied; and 21(8.9%) had been lost to follow-up. Out of the total number of women, 44(18.7%) were adolescents, 152(65.2%) were white and 201(88.5%) had an education ≥9 years. Women who remained pregnant had a known aggressor, disclosed the pregnancy (p < 0.001) and were more ambivalent (p < 0.001) than the other groups. Gestational age was higher in the denied abortion group than in the performed abortion group (p < 0.001). Feelings related to decision-making about abortion affected all groups, with differences. It is important to give women space to be heard, so they can make their own decisions. Abortion care is possible in places with restrictive laws; however, women with more vulnerable characteristics did not seek the service. Legal restrictions interfere with women's decision-making about abortion and can promote inequality in gaining access to health services. [ABSTRACT FROM AUTHOR]

Introduction: Abortion was legal and available at one facility in Mississippi before the June 2022 United States Supreme Court decision in Dobbs v. Jackson Women's Health Organization. Residents' awareness of abortion's legality and knowledge of how to obtain an abortion – indicators of one's ability to seek abortion care if needed – may have varied by their proximity to facility-based care. Methods: Between September 2020 and February 2021, we used social media to recruit Mississippi residents assigned female at birth who were aged 18–45 years and not pregnant or planning pregnancy for an online survey about their reproductive healthcare access. We used multivariable-adjusted Poisson regression models with robust standard errors to assess whether residing ≥ 50 miles from an abortion facility (versus < 50 miles) was associated with three indicators that support one's ability to seek care: awareness of legality, knowledge of a facility, and awareness of self-managed abortion in the community. Results: Of 565 respondents, 262 lived < 50 miles and 303 lived ≥ 50 miles from a facility. Overall, 57% believed that abortion was legal in Mississippi, 26% correctly identified an abortion facility, and 29% had heard about self-managed abortion in their community. Those who lived ≥ 50 miles (vs < 50 miles) from a facility were less often aware that abortion was legal (49% versus 67%; Prevalence Ratio [PR]: 0.82, 95% CI: 0.70–0.95) and less often able to identify an abortion facility (15% versus 38%; PR: 0.52, 95% CI: 0.38–0.72). There was not a detectable difference in awareness of self-managed abortion between distance groups (32% versus 25%; p = 0.104). Conclusions: Many Mississippians face information barriers about abortion legality and location of an abortion facility, particularly those living further from care. Policy Implications: Following implementation of Mississippi's law prohibiting most abortions, efforts to bridge existing and new information gaps about abortion will be needed to support residents' reproductive autonomy. [ABSTRACT FROM AUTHOR]

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After the legalization of abortion in 2018, Ireland needed clinicians to become abortion providers and make this political win a medical reality. Yet Irish doctors had next‐to‐no training in abortion care, and barriers ranging from stigma to economic pressures in the healthcare system impacted doctors' desire to volunteer. How did hundreds of Irish doctors make the shift from family doctor to abortion provider? Drawing on ethnographic research conducted between 2017 and 2020, this article explores the process by which Irish general practitioners became abortion providers, attending to the material impact of medical technologies on that journey. Drawing from medical anthropologists who have examined similar themes of agency, pharmaceuticals, and medico‐legal frameworks within the topic of assisted dying, I build on Anita Hannig's idea of "agentive displacement" to frame the productive impact of abortion pills on this transition. [ABSTRACT FROM AUTHOR]

The article discusses the impact of the Dobbs v. Jackson Women's Health Organization decision on resident training in obstetrics and gynecology in Wisconsin. Following the decision, the state's abortion clinics closed, and hospital committees had to determine how physicians would continue to provide care to pregnant patients. The decision resulted in a lack of abortion training for residents, leading to a decrease in the number of procedures performed. The article emphasizes the need for support and advocacy for abortion education and access in all healthcare settings. [Extracted from the article]

Key Points: Question: To what extent has the provision of medications for self-managed abortion outside the formal US health care setting increased in the 6 months following the Dobbs v Jackson Women's Health Organization decision? Findings: In this cross-sectional US-wide study, the total number of provisions of medications for self-managed abortion increased by an estimated 27 838 in the 6 months after Dobbs (July-December 2022) vs what would have been expected based on pre-Dobbs levels. Meaning: Provision of medications for self-managed abortion in the US increased in the 6 months after Dobbs. A substantial number of people accessed abortion medications despite implementation of state-level bans and restrictions. Clinicians should be prepared to meet the needs of patients who may be considering self-managed medication abortion or who need or want to connect with the formal health care setting for postabortion care. Importance: The Supreme Court decision in Dobbs v Jackson Women's Health Organization overturned the right to choose abortion in the US, with at least 16 states subsequently implementing abortion bans or 6-week gestational limits. Prior research indicates that in the 6 months following Dobbs, approximately 32 360 fewer abortions were provided within the US formal health care setting. However, trends in the provision of medications for self-managed abortion outside the formal health care setting have not been studied. Objective: To determine whether the provision of medications for self-managed abortion outside the formal health care setting increased in the 6 months after Dobbs. Design, Setting, and Participants: Cross-sectional study using data from sources that provided abortion medications outside the formal health care setting to people in the US between March 1 and December 31, 2022, including online telemedicine organizations, community networks, and online vendors. Using a hierarchical bayesian model, we imputed missing values from sources not providing data. We estimated the change in provision of medications for self-managed abortion after the Dobbs decision. We then estimated actual use of these medications by accounting for the possibility that not all provided medications are used by recipients. Exposure: Abortion restrictions following the Dobbs decision. Main Outcomes and Measures: Provision and use of medications for a self-managed abortion. Results: In the 6-month post-Dobbs period (July 1 to December 31, 2022), the total number of provisions of medications for self-managed abortion increased by 27 838 (95% credible interval [CrI], 26 374-29 175) vs what would have been expected based on pre-Dobbs levels. Excluding imputed data changes the results only slightly (27 145; 95% CrI, 25 747-28 246). Accounting for nonuse of medications, actual self-managed medication abortions increased by an estimated 26 055 (95% CrI, 24 739-27 245) vs what would have been expected had the Dobbs decision not occurred. Conclusions and Relevance: Provision of medications for self-managed abortions increased in the 6 months following the Dobbs decision. Results suggest that a substantial number of abortion seekers accessed services despite the implementation of state-level bans and restrictions. This study assesses whether the provision of medications for self-managed abortion outside the formal US health care setting increased during the 6 months after the Supreme Court decision in Dobbs v Jackson Women's Health Organization overturned the right to choose abortion in the US. [ABSTRACT FROM AUTHOR]

Over the last decade, activists in Latin America have expanded access to safe abortion through processes of accompaniment. Abortion accompaniment is characterised by activism and community-based strategies to facilitate access to, and safe use of, medication abortion, mainly outside clinical contexts. Drawing on findings from a survey of 515 activists who were part of Accompaniment Collectives in Latin America, this study describes the organisation of these collectives, barriers and facilitators to their activism, and how accompaniers perceive the impact and future of abortion accompaniment. Accompaniment Collectives are organised and flexible and operate in diverse social and legal contexts. The main goals of accompaniment are the normalisation and social decriminalisation of abortion culturally (84%); the social construction of autonomy (79%); and the protection of people's freedom (73%), life (71%) and health (67%). Activists in legally restrictive settings identified limited access to abortion medication (73%) and restrictive laws (71%) as the main barriers to accompaniment, while health care personnel objecting to abortion provision on grounds of conscience was most common in legally permissive settings (64%). Collectives have developed strategies to overcome such barriers to and expanding access to abortion care. Activists expect accompaniment to continue regardless of the legal status of abortion. [ABSTRACT FROM AUTHOR]

An overwhelming body of evidence supports a negative relationship between women's empowerment and fertility. In this paper, we evaluate whether this relationship holds in a setting with a high degree of son preference and limited access to abortion services by focusing on rural India. We exploit the reforms to the Hindu Succession Act that improved female empowerment by mandating equal inheritance rights for women to assess the reform's impact on women's fertility. Using NFHS‐3 data and a difference‐in‐differences estimation, our results show that women who benefitted from the reform had more children than their counterparts. We attribute this increase in fertility to women's ability to use the stopping rule to achieve son preference. Finally, women impacted by the reform had a higher proportion of sons for a given family size, indicating stronger inherent son preference among treated women. [ABSTRACT FROM AUTHOR]

This article critically explores understandings of autonomy through a feminist activist ethnographic account of grassroots accompaniment practices in support of women seeking abortions in Tijuana, Mexico. Historically, feminist demands for abortion rights in Mexico have drawn on liberal feminist notions of choice and international frameworks of human rights. These demands focus on personal agency and locate bodily autonomy as contingent on the state through favorable legislation and public abortion services. Yet new generations of feminists, who operate in complex contexts of structural violence, seek to remove abortion entirely from the purview of the state. By providing information and medication so women can safely induce their own abortions, these feminists focus on how abortions are carried out and in doing so expand understandings of bodily autonomy beyond the conditionality of liberal choice and what the state makes (im)possible. I utilize the decolonial Latin American feminist concepts of cuerpo-territorio (body-territory) and poner el cuerpo (to put one's body on the line) to argue that autonomy in the context of accompaniment practice can be understood as a relational process that creates subjectivities through collective, tactical, embodied, and loving abortion care and pushes back against the structural and pervasive violent control of women's bodies. [ABSTRACT FROM AUTHOR]

In September 2021, the Mexican Supreme Court issued a decision disallowing any federal or local judicial authority to indict someone for the offense of voluntary or consensual abortion. This decision also declared unconstitutional penalties imposed on medical personnel who facilitate or assist such procedures. Furthermore, the Court decided that limiting access to abortion in cases of rape to a specific time frame was disproportionate. Later on, in September 2023, the Supreme Court confirmed that absolute criminalization of abortion was unconstitutional and declared that the rule supporting criminalization in the Federal Penal Code was without effects. Consequently, healthcare providers who work in public federal health institutions cannot be criminalized for guaranteeing the right to abortion. This article reviews the reasons advanced by the Supreme Court to guarantee the right of reproductive self‐determination, as well as the effects of both decisions beyond the decriminalization of abortion by Mexican federal and state legislatures. The paper also examines the scope and limitations of these rulings and identifies the remaining challenges regarding voluntary abortion procedures in Mexico. Synopsis: This article reviews how the Mexican Supreme Court decriminalized abortion in 2021 and 2023 and the effects of the decisions for promoting reproductive health care and self‐determination. [ABSTRACT FROM AUTHOR]

"I believe cities make decisions all the time based on the health and welfare of their residents. If an abortion facility moved into Abilene, TX, it's not Austin, TX's problem. It's not Washington D.C.'s problem. It's Abilene's problem." Mark Lee Dickson, Right to Life of East Texas. [ABSTRACT FROM AUTHOR]

The Health (Regulation of Termination of Pregnancy) Act 2018 was commenced on 01/01/2019 in Ireland. The Act provides for legal termination of pregnancy under defined circumstances including for any reason at < 12 weeks gestation; and where two doctors agree there is 'a condition affecting the foetus that is likely to lead to the death of the foetus either before, or within 28 days of, birth'. As such, abortion for congenital anomaly (CA) can occur at a number of time points, depending on the adjudged severity. Infants born with CAs frequently require significant medical intervention and account for a high proportion of admissions to paediatric intensive care units (PICUs). The purpose of this paper was to evaluate the number of infants with CAs admitted to an Irish PICU in the period before and after the implementation of the Act. All PICU admissions < 1 month of age to a single Irish paediatric hospital between 2012 and 2021 were analysed. CAs were recorded, and the periods before and after the commencement of the Act compared. We found a difference in admissions involving CAs, particularly those related to congenital heart disease involving single ventricle anatomy. It is plausible that this difference was as a result of improved access to abortion services following the implementation of the Act. This article explores the legal conditions related to the abortion of a foetus with a CA in Ireland, and the possible impact of the Independent Review of the Operation of the Health (Regulation of Termination of Pregnancy) Act 2018. [ABSTRACT FROM AUTHOR]

Relative to neighboring countries, Zambia has among the most progressive abortion policies, but numerous sociopolitical constraints inhibit knowledge of pregnancy termination rights and access to safe abortion services. Multistage cluster sampling was used to randomly select 1,486 women aged 15–44 years from households in three provinces. We used latent class analysis (LCA) to partition women into discrete groups based on patterns of endorsed support for legalized abortion on six socioeconomic and health conditions. Predictors of probabilistic membership in latent profiles of support for legal abortion services were identified through mixture modeling. A three‐class solution of support patterns for legal abortion services emerged from LCA: (1) legal abortion opponents (∼58 percent) opposed legal abortion across scenarios; (2) legal abortion advocates (∼23 percent) universally endorsed legal protections for abortion care; and (3) conditional supporters of legal abortion (∼19 percent) only supported legal abortion in circumstances where the pregnancy threatened the fetus or mother. Advocates and Conditional supporters reported higher exposure to family planning messages compared to opponents. Relative to opponents, advocates were more educated, and Conditional supporters were wealthier. Findings reveal that attitudes towards abortion in Zambia are not monolithic, but women with access to financial/social assets exhibited more receptive attitudes towards legal abortion. [ABSTRACT FROM AUTHOR]

This qualitative study conducted between November 2020 and March 2021 in the US state of Mississippi examines the experiences of 25 people who obtained medication abortion at the state's only abortion facility. We conducted in-depth interviews with participants after their abortions until concept saturation was reached, and then analysed the content using inductive and deductive analysis. We assessed how people use embodied knowledge about their individual physical experiences such as pregnancy symptoms, a missed period, bleeding, and visual examinations of pregnancy tissue to identify the beginning and end of pregnancy. We compared this to how people use biomedical knowledge such as pregnancy tests, ultrasounds, and clinical examinations to confirm their self-diagnoses. We found that most people felt confident that they could identify the beginning and end of pregnancy through embodied knowledge, especially when combined with the use of home pregnancy tests that confirmed their symptoms, experiences, and visual evidence. All participants concerned about symptoms sought follow-up care at a medical facility, whereas people who felt confident of the successful end of the pregnancy did so less often. These findings have implications for settings of restricted abortion access that have limited options for follow-up care after medication abortion. [ABSTRACT FROM AUTHOR]

A rising percentage of patients are electing medication abortion over procedural abortion for increased safety and privacy. Access to medication abortion is essential healthcare, but many Americans face unsurmountable barriers when pursuing this option. This has been in large part due to unnecessary restrictions imposed by the United States Food and Drug Administration (FDA) Risk Evaluation and Mitigation Strategy (REMS) for mifepristone, used in combination with misoprostol for medication abortion. Moreover, many states have imposed additional restrictions on abortion, further impeding access to care. Since its original approval in 2000, mifepristone can only be prescribed by certified prescribers. Until recently, mifepristone could only be dispensed by certified prescribers, whereby more accessible community and mail‐order pharmacies were prohibited from dispensing mifepristone. During the Coronavirus disease 2019 public health emergency, there was a temporary allowance for certified prescribers to utilize mail or mail‐order pharmacies to deliver medications to patients. In January 2023, the FDA approved modifications to the mifepristone REMS to allow certified pharmacies to dispense the medication. Given the established safety and effectiveness of mifepristone, the evidence supports its distribution via pharmacies and leveraging pharmacists to expand medication abortion access. Pharmacists are one of the most widely accessible healthcare providers and their responsibility centers on patient and medication safety and improving health outcomes. This article, an opinion of the American College of Clinical Pharmacy Women's Health Practice and Research Network, adds the voice of members of the pharmacy profession to the collective efforts to ensure access to medication abortion, including pharmacist dispensing of mifepristone. We encourage pharmacists to embrace this fresh opportunity to provide medication abortion care in their communities. [ABSTRACT FROM AUTHOR]

The article discusses how the Free Access to Clinic Entrance (FACE) Act of 1994 adversely affects the abortion movements in the U.S. following the Supreme Court's ruling reversing Roe v. Wade in the case Dobbs v. Jackson Women's Health Organization. Also cited are the rise in violent attacks against abortion clinics and providers after the ruling and the prosecution by the administration of President Joe Biden of the perpetrators of said assaults.

This study highlights the challenges of addressing abortion stigma and misinformation among Chinese youth. The research aims to fill the identified gaps by employing a grounded theory approach to qualitatively analyze the literature on sexual reproductive health and education in China. The results are synthesized into the Stigmatization and Sexual Reproductive Health Issues (S&SRHI) framework, offering a comprehensive understanding of the factors contributing to stigma surrounding sexual and reproductive health education and services provision. The study recommends using a Peer-led intervention to disseminate accurate information, foster open dialogues, and reduce stigma, thus enhancing knowledge, attitudes, and access to abortion services, informing policy discussions, and guiding the design of effective sexual education programs. However, the study acknowledges limitations and highlights the need for future research to focus on evaluating the effectiveness of this approach and developing a more comprehensive and cultural context framework for addressing abortion stigma. [ABSTRACT FROM AUTHOR]

The article reflects on the profound impact of the Dobbs decision on OB/GYN (Obstetrics/Gynecology) residents in states with restrictive abortion laws, detailing how it has affected their training, patient care, and professional outlook.

The article presents a case study of a patient with abdominal ileus masquerading as acute coronary syndrome, underscoring the importance of considering extra-cardiac pathophysiology in evaluating cardiac complaints, particularly in the context of abdominal distention, which can exert pressure on neighboring organs within the thoracic cavity, potentially leading to myocardial ischemia and electrocardiographic changes consistent with myocardial infarction.