RESUMO
Misleading statements in a recent Obstetrics & Gynecology article require correction. No state has an abortion law that is a total ban on abortion. Every state law permits abortion when necessary to save a mother's life. Texas law does not require an "imminent" risk and allows a doctor to use his "reasonable medical judgment" to determine if an abortion is necessary to prevent a "risk" of maternal death. Similarly, Idaho allows a doctor to use his "good faith medical judgment" to determine when to intervene, without need for "immediacy".
Assuntos
Aborto Induzido , Humanos , Feminino , Gravidez , Texas , Idaho , Estados Unidos , Aborto Induzido/legislação & jurisprudência , Valor da Vida , Aborto Legal/legislação & jurisprudênciaRESUMO
Trained for decades to analyze risks, benefits, unique body compositions, and complex medical scenarios, healthcare providers are now faced with one of medicine's most trying obstacles: how to practice medicine when new abortion bans contradict best practice standards. Drawn from qualitative interviews with medical providers in Tennessee, USA conducted between October 2022 and December 2022, this study shows how medical providers often must make medical decisions based on legal risks as opposed to standards of care. This is particularly significant as malpractice insurance does not cover criminal charges. In states with abortion bans, often hastily implemented and subject to changes by lawmakers, medical providers are now practicing a new kind of defensive medicine in an effort to protect themselves from legal threats. We call this hesitant medicine, where providers often experience a tension between their own legal protection and the well-being of their patients, making them hesitant to provide necessary abortion care. This has serious, far-reaching consequences. We focus on three distinct arenas impacted by this new form of defensive medicine, specifically: providers' decision-making around patient care, impacts on patient relationships, and finally, what we call the ultimate defense, leaving states with abortion bans to move to states with fewer legal risks. We conclude with commentary on potential ways to reduce the negative impacts of these trends.
Assuntos
Aborto Induzido , Humanos , Feminino , Tennessee , Gravidez , Aborto Induzido/legislação & jurisprudência , Pesquisa Qualitativa , Medicina Defensiva , Pessoal de Saúde/psicologia , Tomada de Decisões , Aborto Legal/legislação & jurisprudênciaRESUMO
Women who are pregnant or recently gave birth are significantly more likely to be killed by an intimate partner than nonpregnant, nonpostpartum women of reproductive age, implicating the risk of fatal violence conferred by pregnancy itself. The rapidly increasing passage of state legislation has restricted or banned access to abortion care across the US. We used the most recent and only source of population-based data to examine the association between state laws that restrict access to abortion and trends in intimate partner violence-related homicide among women and girls ages 10-44 during the period 2014-20. Using robust difference-in-differences ecologic modeling, we found that enforcement of each additional Targeted Regulation of Abortion Providers (TRAP) law was associated with a 3.4 percent increase in the rate of intimate partner violence-related homicide in this population. We estimated that 24.3 intimate partner violence-related homicides of women and girls ages 10-44 were associated with TRAP laws implemented in the states and years included in this analysis. Assessment of policies that restrict access to abortion should consider their potential harm to reproductive-age women through the risk for violent death.
Assuntos
Aborto Induzido , Homicídio , Violência por Parceiro Íntimo , Humanos , Feminino , Violência por Parceiro Íntimo/estatística & dados numéricos , Violência por Parceiro Íntimo/legislação & jurisprudência , Homicídio/estatística & dados numéricos , Homicídio/legislação & jurisprudência , Estados Unidos , Adolescente , Gravidez , Adulto , Aborto Induzido/legislação & jurisprudência , Aborto Induzido/estatística & dados numéricos , Criança , Adulto Jovem , Governo Estadual , Acessibilidade aos Serviços de Saúde/legislação & jurisprudência , Aborto Legal/legislação & jurisprudência , Aborto Legal/estatística & dados numéricosRESUMO
This study examines voting in the 2022 United States congressional elections, contests that were widely expected to produce a sizable defeat for Democratic candidates for largely economic reasons. Based on a representative national probability sample of voters interviewed in both 2020 and 2022, individuals who changed their vote from one party's congressional candidate to another party's candidate did not do so in response to the salience of inflation or declining economic conditions. Instead, we find strong evidence that views on abortion were central to shifting votes in the midterm elections. Americans who favored (opposed) legal abortions were more likely to shift from voting for Republican (Democratic) candidates in 2020 to Democratic (Republican) candidates in 2022. Since a larger number of Americans supported than opposed legal abortions, the combination of these shifts ultimately improved the electoral prospects of Democratic candidates. New voters were especially likely to weigh abortion views heavily in their vote-shifting calculus. Likewise, those respondents whose confidence in the US Supreme Court declined from 2020 to 2022 were more likely to shift from voting for Republican to Democratic congressional candidates. We provide direct empirical evidence that changes in support for the Supreme Court, a nonpartisan branch of the federal government, are implicated in partisan voting behavior in another branch of government. We explore the implications of these findings for prevalent assumptions about how economic conditions influence voting, as well as for the relationship between the judiciary and electoral politics.
Assuntos
Política , Estados Unidos , Humanos , Feminino , Aborto Legal/legislação & jurisprudência , Gravidez , Aborto Induzido/legislação & jurisprudência , Decisões da Suprema Corte , VotaçãoRESUMO
The laws exacerbate stigma and impede access to needed health care.
Assuntos
Estupro , Sobreviventes , Humanos , Feminino , Sobreviventes/psicologia , Estupro/psicologia , Estupro/legislação & jurisprudência , Gravidez , Estigma Social , Estados Unidos , Acessibilidade aos Serviços de Saúde/legislação & jurisprudência , Aborto Induzido/legislação & jurisprudência , Aborto Legal/legislação & jurisprudênciaRESUMO
This Viewpoint breaks down the myriad ways the Alabama Supreme Court decision to declare frozen embryos as legal equivalents to children harms the health of mothers and fetuses, limits reproductive decision-making based on genetics and out-of-reach costs, and impedes research.
Assuntos
Regulamentação Governamental , Jurisprudência , Medicina Reprodutiva , Governo Estadual , Feminino , Humanos , Gravidez , Aborto Legal/legislação & jurisprudência , Alabama , Medicina Reprodutiva/legislação & jurisprudência , Estados UnidosAssuntos
Aborto Induzido , Estruturas Embrionárias , Assistência ao Paciente , Saúde Reprodutiva , Técnicas de Reprodução Assistida , Saúde da Mulher , Humanos , Alabama , Ativismo Político , Estados Unidos , Aborto Legal/legislação & jurisprudência , Aborto Induzido/legislação & jurisprudência , Assistência ao Paciente/normas , Saúde da Mulher/legislação & jurisprudência , Saúde da Mulher/normas , Saúde Reprodutiva/legislação & jurisprudência , Saúde Reprodutiva/normas , Técnicas de Reprodução Assistida/legislação & jurisprudênciaRESUMO
In this Viewpoint, the Supreme Court case FDA v AHM is used to illustrate the tension the FDA faces between science and politics, and state authority over abortion vs federal authority over which drugs may be marketed nationwide.
Assuntos
Abortivos , Aborto Induzido , Mifepristona , Política , Decisões da Suprema Corte , United States Food and Drug Administration , Feminino , Humanos , Gravidez , Aborto Induzido/legislação & jurisprudência , Aborto Induzido/métodos , Aborto Legal/legislação & jurisprudência , Aborto Legal/métodos , Estados Unidos , United States Food and Drug Administration/legislação & jurisprudência , Mifepristona/uso terapêutico , Abortivos/uso terapêuticoRESUMO
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 32â¯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 27â¯838 (95% credible interval [CrI], 26â¯374-29â¯175) vs what would have been expected based on pre-Dobbs levels. Excluding imputed data changes the results only slightly (27â¯145; 95% CrI, 25â¯747-28â¯246). Accounting for nonuse of medications, actual self-managed medication abortions increased by an estimated 26â¯055 (95% CrI, 24â¯739-27â¯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.
Assuntos
Abortivos , Aborto Induzido , Acessibilidade aos Serviços de Saúde , Decisões da Suprema Corte , Feminino , Humanos , Gravidez , Abortivos/provisão & distribuição , Abortivos/uso terapêutico , Aborto Induzido/legislação & jurisprudência , Aborto Induzido/métodos , Aborto Legal/legislação & jurisprudência , Aborto Legal/métodos , Estudos Transversais , Mifepristona/provisão & distribuição , Mifepristona/uso terapêutico , Misoprostol/provisão & distribuição , Misoprostol/uso terapêutico , Estados Unidos/epidemiologia , Autocuidado/métodos , Autocuidado/tendências , Acessibilidade aos Serviços de Saúde/legislação & jurisprudência , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/tendências , InternacionalidadeRESUMO
This Viewpoint outlines the potential effects of the Supreme Court case regarding mifepristone restrictions: a decision for the FDA would allow current dispensing, while ruling against the FDA would severely curtail access to reproductive health options.
Assuntos
Abortivos , Aborto Legal , Acessibilidade aos Serviços de Saúde , Mifepristona , Serviços de Saúde Reprodutiva , Decisões da Suprema Corte , United States Food and Drug Administration , Humanos , Estados Unidos , United States Food and Drug Administration/legislação & jurisprudência , Mifepristona/uso terapêutico , Abortivos/uso terapêutico , Medicamentos sem Prescrição/uso terapêutico , Acessibilidade aos Serviços de Saúde/legislação & jurisprudência , Acessibilidade aos Serviços de Saúde/tendências , Aborto Induzido/legislação & jurisprudência , Aborto Induzido/métodos , Aborto Induzido/tendências , Aborto Legal/legislação & jurisprudência , Aborto Legal/métodos , Aborto Legal/tendências , Serviços de Saúde Reprodutiva/legislação & jurisprudência , Serviços de Saúde Reprodutiva/tendênciasAssuntos
Aborto Induzido , Aborto Legal , Estupro , Feminino , Humanos , Gravidez , Aborto Induzido/legislação & jurisprudência , Aborto Induzido/estatística & dados numéricos , Aborto Legal/legislação & jurisprudência , Aborto Legal/estatística & dados numéricos , Estupro/legislação & jurisprudência , Estupro/estatística & dados numéricos , Estados Unidos/epidemiologiaRESUMO
This Viewpoint evaluates Texas' proposals to define the scope of the life exception for the state's abortion ban and argues that these approaches do not allow physicians to follow the national standards of care, avoid criminal liability, or have sufficient notice of what the law permits.
Assuntos
Aborto Induzido , Aborto Espontâneo , Responsabilidade Legal , Feminino , Humanos , Gravidez , Aborto Induzido/legislação & jurisprudência , Aborto Legal/legislação & jurisprudência , Serviços de Planejamento Familiar , Responsabilidade SocialAssuntos
Abortivos , Aborto Induzido , Aborto Legal , Participação do Paciente , Feminino , Humanos , Gravidez , Aborto Induzido/legislação & jurisprudência , Aborto Induzido/métodos , Aborto Induzido/estatística & dados numéricos , Aborto Legal/legislação & jurisprudência , Aborto Legal/métodos , Aborto Legal/estatística & dados numéricos , Estados Unidos/epidemiologia , Abortivos/provisão & distribuição , Abortivos/uso terapêutico , Previsões , Decisões da Suprema Corte , Participação do Paciente/estatística & dados numéricosRESUMO
This study quantifies the change in travel times for military service personnel to abortion facilities following the US Supreme Court Dobbs decision and estimates the cost of an abortion-related travel reimbursement policy.
Assuntos
Aborto Induzido , Aborto Legal , Militares , Decisões da Suprema Corte , Viagem , Feminino , Humanos , Gravidez , Aborto Induzido/economia , Aborto Induzido/legislação & jurisprudência , Aborto Legal/economia , Aborto Legal/legislação & jurisprudência , Militares/legislação & jurisprudência , Estados Unidos , Viagem/economia , Viagem/legislação & jurisprudência , Fatores de TempoRESUMO
Importance: The 2022 US Supreme Court decision Dobbs v Jackson Women's Health Organization overturned federal protections to abortion care, allowing many states to severely restrict or ban access to abortion. Given the implications of the Dobbs ruling, there is a need to understand the full consequences of restricted abortion access. Before 2022, many states restricted access to safe and legal abortions through Targeted Regulation of Abortion Providers (TRAP) laws, which provide a historical mode for estimating the consequences of abortion restrictions. Objective: To use TRAP law enactment as a natural experiment to quantify the association between restricted abortion access and foster care entries. Design, Setting, and Participants: In this cohort study, data on the enactment of TRAP laws and case-level data on foster care entries were used to estimate the association between restricted abortion access and foster care entries in each of the 50 US states and the District of Columbia. The sample included children conceived between January 1, 1990, and December 31, 2011, who were placed into foster care at any point between January 1, 2000, and December 31, 2020. Data analysis was performed from January 2023 to July 2023. Exposures: Restricted abortion access due to state-level TRAP laws during pregnancy. Main Outcomes and Measures: The main outcome was the number of children entering foster care in each state, measured by year of child conception. The analysis was performed using a generalized difference-in-differences design, comparing entries into foster care in states with TRAP laws to states without TRAP laws, before and after their implementation. Results: This study included 4â¯179â¯701 children who were placed into foster care during the study period, with 11â¯016â¯561 entries. More than half of the children were male (51.4%), and the mean (SD) age was 7.4 (5.2) years. There was an 11% increase in foster care placement after abortion access was restricted in states with TRAP laws, relative to states without TRAP laws (incidence rate ratio [IRR], 1.11 [95% CI, 1.01-1.23]). These laws had significant consequences for Black children (IRR, 1.15 [95% CI, 1.05-1.28]) and racial and ethnic minority children (IRR, 1.15 [95% CI, 1.02-1.30]). The increase in entries due to TRAP laws was particularly attributable to housing inadequacy (IRR, 1.21 [95% CI, 1.11-1.32]). Conclusions and Relevance: Restricted abortion access can have numerous consequences, and these findings reveal a heightened strain on the US foster care system, particularly affecting marginalized racial and ethnic communities and financially vulnerable families. These placements have been shown to have lifelong consequences for children and substantial costs for both states and the federal government. To further examine the widespread implications of the overturning of Roe v Wade, future studies should forecast the expected increase in foster care entries and estimate the expenditure needed to support these children.