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1.
Soc Sci Med ; 350: 116912, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38723584

RESUMO

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 & jurisprudência
2.
Health Aff (Millwood) ; 43(5): 682-690, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38709960

RESUMO

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 numéricos
3.
Proc Natl Acad Sci U S A ; 121(21): e2319512121, 2024 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-38739783

RESUMO

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 , Votação
4.
Issues Law Med ; 39(1): 76-81, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38771716

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 & jurisprudência
7.
J Nepal Health Res Counc ; 21(4): 692-696, 2024 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-38616604

RESUMO

In Nepal, abortion was legalized in 2002. Yet many women are denied abortion services. Women denied abortion services may either continue their pregnancies or find abortion care elsewhere. However, what is not known is the consequences on women, and their children after accessing abortion services or after being denied abortion services. This comment aims to understand the cause of death of women who sought abortion services between 2019 and 2020 and were enrolled in a longitudinal nationwide study of the consequences of legal abortion access in Nepal. Women were interviewed 6 weeks and every 6 months for 3 years after seeking abortion. During the follow-up interviews, the field research assistants were informed about the death of the clients. Once the death was reported, a trained senior research staff visited the deceased persons house and interviewed family members including husbands, maternal parents or in-laws to explore the cause of death. A total of nine deaths were reported between April 2019 and December 2022. Out of nine deceased women, four received abortions while five of them were initially denial abortion services. The majority of the deaths were due to suicide followed by tuberculosis. None of the deaths were caused by abortion or birth. Keywords: Death; Nepal; reproductive ages; womens health.


Assuntos
Aspirantes a Aborto , Aborto Induzido , Gravidez , Criança , Feminino , Humanos , Nepal/epidemiologia , Aborto Legal , Família
10.
Eur J Contracept Reprod Health Care ; 29(3): 131-137, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38683765

RESUMO

METHODS: 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%. RESULTS: 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). CONCLUSION: 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.


Assuntos
Aborto Legal , Humanos , Feminino , Gravidez , Estudos Retrospectivos , Brasil , Adulto , Aborto Legal/legislação & jurisprudência , Aborto Legal/estatística & dados numéricos , Aborto Legal/psicologia , Adulto Jovem , Adolescente , Aborto Induzido/legislação & jurisprudência , Aborto Induzido/psicologia , Aborto Induzido/estatística & dados numéricos , Idade Gestacional , Resultado da Gravidez , Aborto Espontâneo/psicologia , Aborto Espontâneo/epidemiologia
14.
JAMA ; 331(13): 1085-1086, 2024 04 02.
Artigo em Inglês | MEDLINE | ID: mdl-38436997

RESUMO

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 Unidos
16.
JAMA ; 331(15): 1269-1270, 2024 04 16.
Artigo em Inglês | MEDLINE | ID: mdl-38526475

RESUMO

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 terapêutico
17.
PLoS One ; 19(3): e0288947, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38551970

RESUMO

INTRODUCTION: On June 24, 2022, the U.S. Supreme Court's decision in Dobbs v. Jackson reversed the precedent set forth by Roe v. Wade, empowering individual states to regulate abortion care. This aftermath of this ruling has given rise to widespread bans, limiting the accessibility of abortion services for patients and impeding providers' ability to deliver a comprehensive spectrum of reproductive health services. Of particular concern is the disproportionate impact on medically underserved groups, further heightening existing social and structural disparities in reproductive health. METHODS: We conducted a scoping review to broadly evaluate the clinical and public health impact of Dobbs on patients' access to abortion care and related reproductive health services, in addition to the training and clinical practice of healthcare providers. We searched eight bibliographic databases (PubMed, Scopus, Embase, PsycINFO, Google Scholar, Science Direct, JSTOR, and Web of Science) and three preprint servers (medRxiv, bioRxiv, and Europe PMC) using various combinations of keywords related to 'abortion', 'Dobbs', and 'Roe' on March 22, 2023. Four reviewers independently screened the studies based on pre-specified eligibility criteria and one reviewer performed data extraction for pre-identified themes. The search was conducted based on PRISMA Extension for Scoping Reviews (PRSIMA-ScR) guidelines. RESULTS: Eighteen studies, comprising 12 peer-reviewed articles and 6 study abstracts, met the inclusion criteria. The studies demonstrated that Dobbs increased demand for contraception, magnified existing travel- and cost-related barriers to access, further polarized views on abortion and complex family planning on social media (e.g., Twitter), and evoked substantial concerns among medical trainees regarding their scope of practice and potential legal repercussions for providing abortion care. CONCLUSION: In the wake of Dobbs v. Jackson, further public health and clinical interventions are urgently needed to bridge disparities in abortion care and reproductive health, mitigating the deleterious consequences of this emerging public health crisis.


Assuntos
Aborto Induzido , Saúde Pública , Feminino , Gravidez , Humanos , Estados Unidos , Pessoal de Saúde , Pacientes , Anticoncepção , Aborto Legal
18.
Perspect Sex Reprod Health ; 56(1): 41-49, 2024 03.
Artigo em Inglês | MEDLINE | ID: mdl-38439171

RESUMO

CONTEXT: Women, transgender men, and gender non-binary individuals facing unwanted pregnancy use online resources for abortion information. We sought to determine the informational and emotional needs that those seeking abortion information on Reddit expressed immediately following the Dobbs v. Jackson Women's Health Organization (Dobbs) decision in the United States. Furthermore, we aimed to understand how the Reddit community addressed these needs. METHODS: We collected posts on Reddit in the subreddit r/abortion that expressed informational or emotional needs related to the Dobbs decision created between June 24, 2022 and July 24, 2022. We identified posts using keywords including "roe," "rvw," and "trigger law" and then manually reviewed them to ensure relevance. We analyzed posts and their comments using qualitative descriptive analysis. RESULTS: One hundred and ten posts met inclusion criteria. Original posters expressed needs for legal and medical information. Posters also expressed need for logistical support, including help accessing medication abortion, traveling out of state, and financing abortion care, and emotional support in general and resulting from fear of parental disapproval and shame relating to abortion stigma. Although responders to these comments addressed these needs by offering general support, accurate information, and reliable resources, intersecting and emotional needs sometimes went unaddressed. CONCLUSION: The Dobbs decision caused confusion and panic among abortion seekers requesting guidance on r/abortion, resulting in informational and emotional needs. While the r/abortion community actively addressed needs, inherent limitations of an online forum prevented some original posters from receiving the multifaceted support they needed.


Assuntos
Aspirantes a Aborto , Aborto Induzido , Gravidez , Masculino , Feminino , Estados Unidos , Humanos , Saúde da Mulher , Emoções , Pais , Aborto Legal
20.
JAMA ; 331(18): 1558-1564, 2024 05 14.
Artigo em Inglês | MEDLINE | ID: mdl-38526865

RESUMO

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.


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 , Internacionalidade
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