Motivation toward vasectomy based on abortion law changes in Oklahoma.

INTRODUCTION: In May 2022, lawmakers in Oklahoma passed House Bill 4327, which outlawed abortion after fertilization. The governor signed the bill on May 25, 2022. It is uncertain whether these changes will motivate more men in Oklahoma to undergo vasectomy. MATERIALS AND METHODS: Males seeking vasectomy were informed of the study and asked to participate. Participants filled out a survey regarding their marital status, number of children, fertility treatment history, and their influences in making the decision to pursue vasectomy. We removed the identifying information from the survey. After collection, the data was imported to a database. Medical records were investigated to confirm patients underwent the procedure. RESULTS: Of the 126 participants, 116 underwent vasectomy. Patients who did not undergo vasectomy tended to be older (38.4 vs. 34.2, p = 0.03). Participants who underwent vasectomy and were concerned about abortion laws tended to be married (69.7 vs. 30.3%, p = 0.04) with fewer children (1.2 vs. 2.3, p < 0.0001). When correlating specifically "concern about abortion laws" and going through with vasectomy, the risk ratio of 1.12 (95% CI 1.04, 1.20) indicates that patients concerned about abortion laws were slightly more likely to undergo vasectomy. CONCLUSIONS: Over 26% of men said that their decisions were somewhat impacted by abortion law changes. The concern about abortion law changes seemed to be predictive of patients undergoing vasectomy. Continued data collection will help determine whether there is a time-sensitive nature regarding the impact of abortion law changes on motivation to vasectomy.

Detecting and Dating Early Non-live Pregnancy Outcomes: Generation of a Novel Pregnancy Algorithm From Norwegian Linked Health Registries.

PURPOSE: Pregnancies ending before gestational week 12 are common but not notified to the Medical Birth Registry of Norway. Our goal was to develop an algorithm that more completely detects and dates all possible pregnancy outcomes (i.e., miscarriages, elective terminations, ectopic pregnancies, molar pregnancies, stillbirths, and live births) by using diagnostic codes from primary and secondary care registries to complement information from the birth registry. METHODS: We used nationwide linked registry data between 2008 and 2018 in a hierarchical manner: We developed the UiO pregnancy algorithm to arrive at unique pregnancy outcomes, considering codes within 56 days as the same event. To estimate the gestational age of pregnancy outcomes identified in the primary and secondary care registries, we inferred the median gestational age of pregnancy markers (45 ICD-10 codes and 9 ICPC-2 codes) from pregnancies registered in the medical birth registry. When no pregnancy markers were available, we assigned outcome-specific gestational age estimates. The performance of the algorithm was assessed by blinded clinicians. RESULTS: Using only the medical birth registry, we identified 649 703 pregnancies, including 1369 (0.2%) miscarriages and 3058 (0.5%) elective terminations. With the new algorithm, we detected 859 449 pregnancies, including 642 712 live-births (74.8%), 112 257 miscarriages (13.1%), 94 664 elective terminations (11.0%), 6429 ectopic pregnancies (0.7%), 2564 stillbirths (0.3%), and 823 molar pregnancies (0.1%). The median gestational age was 10+1 weeks (IQR 10+0-12+2) for miscarriages and 8+0 weeks (IQR 8+0-9+6) for elective terminations. Gestational age could be inferred using pregnancy markers for 66.3% of miscarriages and 47.2% of elective terminations. CONCLUSION: The UiO pregnancy algorithm improved the detection and dating of early non-live pregnancy outcomes that would have gone unnoticed if relying solely on the medical birth registry information.

Longitudinal Impact of Dobbs v Jackson Women's Health Organization on Abortion Service Delivery in Ohio, 2022‒2023.

Objectives. To assess the impact of Ohio's abortion policy changes on abortion provision following Dobbs v Jackson Women's Health Organization. Methods. We analyzed quantitative and write-in responses from an ongoing survey of 6 abortion facilities in Ohio for 3 time periods: January‒June 2022 (pre-Dobbs), July‒September 2022 (6-week ban in effect), and October 2022‒June 2023 (post-Dobbs, ban blocked). We disaggregated counts by method, gestation, and state of residence. Results. Following Dobbs, Ohio banned abortions after detection of embryonic cardiac activity, and monthly abortion provision decreased 56%. Several months after the ban was lifted, monthly abortion means exceeded pre-Dobbs means. The percentage of patients from out of state increased over time. Conclusions. The post-Dobbs enactment of a restrictive abortion ban drastically reduced availability of reproductive health care in Ohio. Nevertheless, Ohio remained an important destination for patients from surrounding states with abortion restrictions. Public Health Implications. Gestational bans decrease access to necessary health care; instead, states like Ohio should work to eliminate barriers to abortion care to support the health and well-being of people in their own and surrounding states. (Am J Public Health. 2024;114(10):1034-1042. https://doi.org/10.2105/AJPH.2024.307775).

Post-Dobbs Abortion Restrictions and the Families They Leave Behind.

The June 24, 2022 US Supreme Court decision in Dobbs v Jackson Women's Health Organization resulted in an expansive restriction on abortion access that had been constitutionally guaranteed for nearly half a century. Currently, 14 states have implemented complete bans on abortion with very limited exceptions, and an additional 7 states have implemented abortion bans at 6 to 18 weeks' gestation. It has been well demonstrated that restrictive policies disproportionately limit abortion access for minoritized people and people of low socioeconomic status; the financial and geographic barriers of these post-Dobbs restrictions will only exacerbate this disparity. Proponents of abortion restrictions, who identify as pro-life, assert that these policies are essential to protect children, women, and families. We examine whether the protection of these groups extends past conception by evaluating the association between state abortion legislation and state-based policies and programs designed to provide medical and social support for children, women, and families. We found that states with the most restrictive post-Dobbs abortion policies in fact have the least comprehensive and inclusive public infrastructure to support these groups. We suggest further opportunities for advocacy. (Am J Public Health. 2024;114(10):1043-1050. https://doi.org/10.2105/AJPH.2024.307792).

Prevalence of pregnancy termination and associated factors among married women in Papua New Guinea: A nationally representative cross-sectional survey.

BACKGROUND: Pregnancy termination or induced abortion is not decriminalized, and access to safe abortion services is largely unavailable in Papua New Guinea (PNG). However, the practice is common throughout the country. This study aimed to estimate the prevalence and determine factors associated with pregnancy termination among married women aged 15-49 years in PNG. METHODS: Secondary data from the 2016-2018 PNG Demographic and Health Survey (PNGDHS) was used. A total weighted sample of 6,288 married women were included. The Complex Sample Analysis method was used to account for the cluster design and sample weight of the study. Chi-square tests and multivariable logistic regression were used to assess factors associated with pregnancy termination. Adjusted odds ratios (aORs) with 95% Confidence Intervals (CIs) were reported. RESULTS: The prevalence of pregnancy termination was 5.3%. Nearly half (45.2%) of all pregnancy terminations occurred in the Highlands region. Women aged 35-44 years (aOR = 8.54; 95% CI: 1.61-45.26), not working (aOR = 6.17; 95% CI: 2.26-16.85), owned a mobile phone (aOR = 3.77; 95% CI: 1.60-8.84), and lived in urban areas (aOR = 5.66; 95% CI: 1.91-16.81) were more likely to terminate a pregnancy. Women who experienced intimate partner violence (IPV) were 2.27 times (aOR = 2.27; 95% CI: 1.17-4.41) more likely to terminate a pregnancy compared to those who did not experience IPV. Women with unplanned pregnancies were 6.23 times (aOR = 6.23; 95% CI: 2.61-14.87) more likely to terminate a pregnancy. Women who knew about modern contraceptive methods and made independent decisions for contraceptive use were 3.38 and 2.54 times (aOR = 3.38; 95% CI: 1.39-8.18 and aOR = 2.54; 95% CI: 1.18-5.45, respectively) more likely to terminate a pregnancy. CONCLUSION: The findings highlight the role of sociodemographic and maternal factors in pregnancy termination among married women in PNG. Efforts aimed at reducing unplanned pregnancies and terminations should focus on comprehensive sexual and reproductive health education and improving easy access to contraceptives for married couples. Post-abortion care should also be integrated into the country's legal framework and added as an important component of existing sexual and reproductive health services.

Choosing to Provide: Early Medical Abortion and Clinician Conscience in Ireland.

Providers are essential to the delivery of abortion care. Yet, they often occupy an ambiguous space in political discourse around abortion. The introduction of a new abortion service in Ireland invites us to look afresh at providers. Since the Health (Regulation of Termination of Pregnancy) Act 2018 came into force, by far the most common form of abortion care has been early medical abortion (EMA). This is typically provided by General Practitioners (GPs), with approximately 10% of GPs having chosen to provide EMA. This article draws on an empirical study of providers to investigate their motivations for, and experiences of, provision and their views on colleagues who have not chosen to provide. The study shows that for many providers, the choice to provide was grounded in a moral commitment to protecting women's rights to autonomy and health and ensuring that the harms of the past were not repeated. The article argues that notwithstanding increased normalisation of EMA in Ireland, conscience still has a role to play in abortion care provision and it is important to reflect on the various aspects of this role.

High-risk factors for massive haemorrhage in medical abortion patients with missed miscarriage.

BACKGROUND: Recently, the incidence of missed miscarriage has gradually increased, and medical abortion is a common method to terminate a pregnancy. In the process of medical abortion, massive vaginal bleeding takes place, leading to emergency surgical haemostasis. Emergency surgery may produce infection and organ damage. Our study aimed to investigate the high-risk factors for massive haemorrhage during a medical abortion. METHODS: A total of 1062 missed miscarriage patients who underwent medical abortion participated in this retrospective study. According to the amount of bleeding, the patients were divided into a massive haemorrhage group and a control group. By comparing the general conditions of the two groups, such as fertility history, uterine surgery history, uterine fibroids, etc., the high-risk factors for massive haemorrhage during medical abortion were identified. RESULTS: Relative to the control group, the massive haemorrhage group exhibited a higher proportion of patients with a previous artificial abortion (51.9% vs. 38.1%, P = 0.001). Additionally, the massive haemorrhage group had a lower percentage of first-time pregnant women (32.1% vs. 40.4%) and a higher proportion of women with shorter pregnancy intervals (44.9% vs. 33.1%, P = 0.03). Furthermore, there were notable differences between the two groups regarding maximum fibroid size, the duration of amenorrhea, and gestational week (P < 0.05). CONCLUSION: In this study, we determined that a history of artificial abortion and an amenorrhea duration of > 11 weeks represented high-risk factors for massive vaginal bleeding during medical abortion in missed miscarriage patients.

Induced abortion incidence and associated factors in a cohort of women living with HIV in Rio De Janeiro, Brazil, 1996-2016.

BACKGROUND: Abortion is a public health problem in Latin America and is more common among women living with HIV. OBJECTIVE: to verify the incidence and factors associated with induced abortion in a cohort of women living with HIV assisted in a reference service for care for individuals with HIV/AIDS in Rio de Janeiro/Brazil. METHODS: Prospective cohort during the period 1996-2016. We estimated the incidence of induced abortions during follow-up in the cohort by calculating person-time incidence rates [per 100 persons-years (PY)] and investigated the factors associated with the outcome "induced abortion" using a generalized linear mixed model. RESULTS: 753 women and 210 pregnancies were included in the present analysis. We estimated an induced abortion incidence rate of 0.68/100 persons-years (95% confidence interval [CI]: 0.47; 0.94) in the study period, with a significant reduction after 2006. The main factors associated with an induced abortion were currently living with a partner (adjusted OR [AdjOR] 0.32 95% CI: 0.10-0.98), number of children (2 children AdjOR 0.12, 95% CI: 0.02-0.95) and the type of antiretroviral treatment used (regimen without Efavirenz: AdjOR: 0.11, 95% CI 0.02-0.70). CONCLUSIONS: We showed a significant reduction in the incidence of induced abortions in a cohort of women living with HIV in Rio de Janeiro, Brazil, probably due to a decrease in the incidence of pregnancies observed in the same period. The factors associated with a lower occurrence of induced abortion suggest a good integration between the clinical and reproductive assistance offered to those women.

Health aspects of the presidential election in the United States.

The prospect of a Biden-Trump rematch had raised concerns. The argument of Trump on the older age of Biden led to a boomerang effect when the latter was replaced by the much younger Kamala Harris whose mixed African and Asian ancestry should lead to her support on international issues. Swing voters might be attracted by her potential as the first female president. Assertive on the politically controversial issue of abortion, Kamala Harris already spent a substantial part of her vice-presidency on women issues. Her promotion of sexual and reproductive rights during the presidential campaign augurs well for restoring those priorities on the American political agenda.

La perspective d'une revanche Biden-Trump avait suscité des inquiétudes. L'argument de Trump sur l'âge avancé de Biden a provoqué un effet boomerang lorsque ce dernier a été remplacé par la bien plus jeune Kamala Harris dont l'ascendance mixte africaine et asiatique devrait lui valoir son soutien sur les questions internationales. Les électeurs swing pourraient être attirés par son potentiel en tant que première femme présidente. Affirmée sur la question politiquement controversée de l'avortement, Kamala Harris a déjà consacré une partie substantielle de sa vice-présidence aux questions féminines. Sa promotion des droits sexuels et reproductifs pendant la campagne présidentielle augure bien du rétablissement de ces priorités sur l'agenda politique américain.

Exploring women's knowledge of abortion legality and association with source of abortion care using population-based survey data in Côte d'Ivoire and Ghana.

BACKGROUND: Knowledge of the conditions under which abortion is legal is important so that people can advocate for their right to abortion care. Yet minimal research has explored the association between women's knowledge of abortion legality and the induced abortion care they receive, particularly using population-based survey data. METHODS: Using national survey data collected by Performance Monitoring for Action (PMA) in Côte d'Ivoire and Ghana, we aimed to compare the prevalence of accurate knowledge of abortion legality, factors associated with knowledge of the law, and the association between knowledge of abortion legality and the source of women's induced abortion care in these two settings. We ran bivariate and multivariable logistic regressions to assess the relationships of interest. RESULTS: We found that awareness and knowledge of the abortion law were low in both Côte d'Ivoire and Ghana. In Cote d'Ivoire, women who were older, more educated, and with past abortion experience were more likely to be aware of the law. In Ghana, knowledge of the law did not vary significantly by demographic characteristics. However, in Ghana, knowledge of the law was correlated with women's use of the formal healthcare system for abortion care, with greater use of clinical sources in rural areas. CONCLUSIONS: It is possible that for populations with reduced access to abortion services, such as those in rural areas, knowledge of the law is advantageous for those seeking facility-based abortion care, particularly in settings where abortion is legal for a range of indications. Interventions seeking to improve access to facility-based abortion care in settings where abortion is legal on various grounds should incorporate education on the legal grounds for abortion.

Knowledge of the conditions under which abortion is legal is important for people to advocate for their right to abortion care, yet minimal research has explored the association between women's knowledge of abortion legality and the abortion care they receive, particularly using population-based survey data. Using national survey data collected by Performance Monitoring for Action (PMA) in Côte d'Ivoire and Ghana, we aimed to compare the prevalence of accurate knowledge of abortion legality, factors associated with knowledge of the law, and the association between knowledge of abortion legality and the source of women's abortion care in these two settings. We ran bivariate and multivariable logistic regressions to assess the relationships of interest. We found that awareness and knowledge of the abortion law were low in both Côte d'Ivoire and Ghana. In Côte d'Ivoire, knowledge was unequally distributed according to sociodemographic factors, while such inequities did not exist in Ghana. However, in Ghana, knowledge of the law was correlated with women's use of the formal healthcare system for abortion care, with greater use of clinical sources in rural areas. It is possible that for populations with reduced access to abortion services, such as those in rural areas, knowledge of the law is advantageous for those seeking facility-based abortion care, particularly in settings where abortion is legal for a range of indications. Interventions seeking to improve access to facility-based abortion care in settings where abortion is legal on various grounds should incorporate education on the legal grounds for abortion.

Abortion Restrictions Threaten Miscarriage Management In The United States.

Miscarriage and abortion require similar clinical management. Restrictions placed on abortion threaten the quality of miscarriage care, a policy spillover that affects many Americans. We combined vital statistics with life-table parameters to estimate that 1,034,000 miscarriages occur annually, including nearly 400,000 in US states with abortion bans. Attempts to restrict mifepristone access further threaten miscarriage management.

Induced abortion after advent of fetal sex detection technology and child sex at birth.

BACKGROUND: National level Sex Ratio at Birth (SRB) is normal in Bangladesh despite its patriarchal social structures, strong son preference, and low fertility level, widely recognized as preconditions for Gender-Biased Sex Selection (GBSS). To better understand this anomaly, we examine the trend in SRB in a sub-district in Bangladesh and assess the impact of the introduction of fetal sex-detection technology and the history of induced abortion on child sex using longitudinal data. METHODS: We have used secondary data collected routinely by icddr, b's Matlab Health and Demographic Surveillance System (HDSS) between 1982 and 2018. All births occurring during this period (N = 206,390) were included in the analyses. We calculated the SRB and used multivariate logistic regression analyses to assess the likelihood of birth of a male child before and after the introduction of ultrasonogram in Matlab. RESULTS: Overall, SRB was within the natural limit (106) during 1982-2018 in Matlab. SRB among women with a history of induced abortion was 109.3 before the introduction of ultrasonography in 2001 and 113.5 - after 2001. Women's history of induced abortion prior to introduction of ultrasonogram (1982-2000) increased the likelihood of birth of a male child 1.06 times (AOR 1.06; 95% CI- 1.01-1.11). In the period after, however, this likelihood was 1.08 (AOR 1.08; 95% CI- 1.02-1.15). CONCLUSIONS: In a context with normal SRB, it was found to be skewed among women who had induced abortion. SRB was relatively more skewed among such women after the advent of ultrasonogram compared to a period without ultrasonogram. Moreover, induced abortion after introduction of fetal sex determination technology increased the likelihood of birth of a male child. These findings suggest the plausibility of GBSS in a sub-group. Further research is needed, particularly in regions with skewed SRB to examine whether GBSS is indeed a threat to Bangladesh.

Knowledge of abortion legality among health facility staff in Ghana.

BACKGROUND: Abortion has been legal for multiple indications in Ghana since 1985, and efforts have been made to expand the availability of safe abortion care in the years since. However clandestine, and potentially unsafe, abortions remain common, suggesting numerous barriers to access persist; one possible barrier is poor knowledge of the abortion law among those working in health facilities. Our study aimed to identify levels of legal knowledge among health facility staff across Ghana. METHODS: Data for this paper are drawn from a nationally representative cross-sectional health facility survey conducted in 2018; our analytic sample includes 340 facilities that provide induced abortion and/or postabortion care (PAC). The survey collected data on provision of abortion and PAC, as well as knowledge of abortion legality and recommendations for reducing unsafe abortion. We used descriptive statistics to examine levels of knowledge and recommendations, and logistic regression to assess associations with individual and facility characteristics. FINDINGS: Comprehensive knowledge of the legal indications for abortion was low among health facility staff; just 6% identified all legal indications, and the majority (83%) underestimated the number of conditions under which abortion is legal. Knowledge was higher for more restrictive indications, such as a woman's life being at risk, which was identified by 72% of respondents, than more broadly interpretable indications, such as mental health, identified by 29%. Respondents in facilities providing both induced abortion and PAC had better knowledge of several legal indications than those in facilities providing PAC only. CONCLUSIONS: Health facility staff have significant gaps in their knowledge of abortion legality. Knowledge of the law among this population is highly important for ensuring that abortion care is made available to the fullest extent of the law. Efforts are needed to improve knowledge of the law among providers and facility staff, particularly for indications with broad interpretability.

Contraception Initiation after Early Abortion in a Family Medicine Setting: A Retrospective Chart Review.

OBJECTIVES: Early abortion increasingly is provided in the primary care setting, allowing improved access, continuity of care, and contraception, if desired. We aimed in this retrospective chart review to describe postabortion contraception provision in a family medicine office. METHODS: Participants were those patients who obtained an induced abortion during an 11-year period at a family medicine office. We documented contraception provision within 30 days of abortion and used simple proportions, Fisher exact tests, and χ2 tests to describe differences in contraceptive provision by type of abortion and continuity status. RESULTS: Most of the patients who underwent abortions (254/353, 72%) had documentation of a contraceptive method within 30 days of abortion, which was similar for patients who had either a medication (124/166, 75%) or an aspiration abortion (130/187, 70%, P = 0.71). The most common contraceptives were contraceptive pills (104/353, 29%) or intrauterine devices (68/353, 19%). Patients who chose a tier 1 method were more likely to have a procedure abortion (50/87, 57%), whereas patients who chose a tier 2 method were likely to have a medication abortion (83/160, 52%). Fewer than half (45%, 158/353, P = 0.0002) were continuity patients and established patients in the primary care office. Most tier 1 contraceptive users were continuity patients (49/87, 60%), whereas most patients without a contraceptive method were noncontinuity patients (72/99, 73%). CONCLUSIONS: The primary care setting is uniquely equipped for providing early abortion and postabortion contraception. Although the providers offered all contraceptive options to eligible patients, continuity patients were more likely to receive more effective contraception in their primary care office.