Serapio_HW1

Serapio_HW1

by Elissa -

Topic: Helping clinics expand abortion services

Background: A major problem in the field of women’s health is restricted access to abortion care. Although most abortions take place early in pregnancy, 9% of women who obtain an abortion do so after the first trimester (at 14 weeks or later).1 This is the population of women for whom this project will be focused.

There are powerful factors that contribute to limited access to abortion services, including laws, stigma, and limited healthcare workforce. In some instances, even if there are no external restrictions, clinics only provide abortion services through 14 gestational weeks. This can result in women being turned away from receiving a wanted abortion (or being referred to clinics that are far away and often women are unable to access those clinics) if they are past that gestational limit.

Evidence for efficacy and health status consequences: The evidence is robust that abortion is a critical part of women’s healthcare2-4 and that there are negative mental health, physical health, and socioeconomic consequences when women are denied wanted abortions.5-9 Increasing access to a more comprehensive set of reproductive health services, including abortions after 14 weeks, has been shown to improve women’s health.2 There are no published studies that I have found that document the impact of a particular clinic expanding its services on health outcomes for women in the catchment area, but this result logically follows from the evidence that does exist. The American College of Obstetricians and Gynecologists (ACOG), the largest professional association of physicians specializing in obstetrics and gynecology in the United States, supports increased access to abortion services.2

Evidence for underutilization: Only 28% of abortion clinics offer abortion beyond 12 weeks gestation.10 Data from the Turnaway Study (a project that investigates the consequences of receiving or being denied a wanted abortion) demonstrate that women seeking later abortions experience significant logistical delays—including difficulties finding a provider, raising funds for the procedure and travel, finding a facility and securing insurance coverage.11

 

 

References

1. Guttmacher Institute, Induced abortion in the United States, Fact Sheet, 2016, https://www.guttmacher.org/fact-sheet/induced-abortion-united-states.

2.. American College of Obstetricians and Gynecologists (ACOG), Committee on Health Care for Underserved Women. ACOG Committee Opinion No. 613: Increasing access to abortion. Obstet Gynecol. 2014; 124:1060-1065.

3. Ganatra B, Faundes A. Role of birth spacing, family planning services, safe abortion services and post-abortion care in reducing maternal mortality. Best Pract Res Clin Obstet Gynaecol. 2016; 36:145-155.

4. Reproductive health in the USA: Must do better. Lancet. 2014; 383:188.

5. Foster DG, Ralph LJ, Biggs MA, Gerdts C, Roberts SCM, Glymour MA. Socioeconomic outcomes of women who receive and women who are denied wanted abortions. American Journal of Public Health (2018) Mar; 108(3):407-413.

6. Roberts SCM, Foster DG, Gould, H, Biggs, MA. Changes in alcohol, tobacco, and drug use over five years after receiving versus being denied a pregnancy termination. Journal of Studies on Alcohol and Drugs (2018) Mar; 79(2):293–301

7. Roberts SCM, Biggs MA, Chibber KS, Gould H, Rocca CH, Foster DG. Risk of violence from the man involved in the pregnancy after receiving or being denied an abortion. BMC Medicine (2014) Sept; 12:144.

8. Upadhyay U, Biggs MA, Foster DG. The effect of abortion on having and achieving aspirational one-year plans. BMC Women’s Health (2015) Nov; 15:102.

9. Biggs MA, Upadhyay U, McCulloch CE, Foster DG. Women’s mental health and well-being five years after receiving or being denied an abortion: A prospective, longitudinal cohort study. JAMA Psychology (2017) Feb; 74(2):169-178.

10. Jones RK, Ingerick M and Jerman J, Differences in abortion service delivery in hostile, middle-ground and supportive states in 2014, Women’s Health Issues, 2018.

11. Foster DG and Kimport K, Who seeks abortions at or after 20 weeks? Perspectives on Sexual and Reproductive Health, 2013, 45(4):210–218.


Re: Serapio_HW1

by Emilia Demarchis -

Hey Elissa,

What a great topic! Are you specifically focusing on clinic-level factors/resources, or will you also be looking at provider training for 2nd trimester abortions? As a family doctor who has found it daunting to continue TAB work in the Bay Area, I'm really interested in efforts to match providers/clinics (such as Creating a Clinician Corps (C3)) and efforts to train up providers (not meaning to be too provider-centric in my post!). 

Thanks for sharing!


Re: Serapio_HW1

by Odmara Barreto Chang -

Elisa,

Interesting topic which shows there is evidence-based data demonstrating the negative consequences of not providing the resources to women in need. It will be interesting to see the role that cultural/social/political/religious influences play in preventing the implementation of the services. Also, implementation of the services is illegal in some countries and I believe some states. Are you narrowing your scope to California? Were you thinking about the expansion of services in the United States?

~ Odmara 

Re: Serapio_HW1

by Naomi Beyeler -

This is a huge challenge in so many places, glad that someone is working on it. You mention many different factors that impact access or lack of access and I'm curious which you see as the most significant and amenable to action at the clinic/health system level. Do you know of any health facilities or systems that have successfully (re-)introduced or expanded abortion services for after 12 weeks, and what some of the factors were that led to success that could be implemented elsewhere?