Inflation in 2022 did not affect congressional voting, but abortion did.

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.

Health-care workforce implications of the Dobbs v Jackson Women's Health Organization decision.

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.

Societal implications of the Dobbs v Jackson Women's Health Organization decision.

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.

Medical students' reproductive health perspectives: Pre- and post-Roe v Wade reversal.

The ability to make informed decisions about reproductive health is a cornerstone principle of the practice of prenatal medical genetics. Unfortunately, these reproductive health decisions have become entangled in the current, contentious political climate. This debate reached an inflection point in 2022 with Dobbs v. Jackson when the Supreme Court of the United States (SCOTUS) overturned the national right to abortion previously established in Roe v. Wade. This decision prompted a reassessment of the opinions of medical students on reproductive health and abortion. Our study focused on a medical school in Alabama, a conservative state that enacted a restrictive abortion ban following the Dobbs ruling. Two surveys, conducted in 2015 and 2022, explored students' viewpoints on reproductive health topics, including abortion. The comparison revealed a significant shift toward more pro-choice perspectives among medical students. Notably, religious affiliation did not consistently align with opinions, as many Christian students supported pro-choice views. Our results suggest that medical students' reproductive health opinions at our institution have shifted to a more pro-choice position over the last decade.

Society for Maternal-Fetal Medicine Position Statement: Access to abortion care.

POSITION: The Society for Maternal-Fetal Medicine supports the right of all individuals to access the full spectrum of reproductive health services, including abortion care. Reproductive health decisions are best made by each individual with guidance and support from their healthcare providers. The Society opposes legislation and policies that limit access to abortion care or criminalize abortion care and self-managed abortion. In addition, the Society opposes policies that compromise the patient-healthcare provider relationship by limiting a healthcare provider's ability to counsel patients and provide evidence-based, medically appropriate treatment.

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).

Unequal Spatial Consequences of Abortion Restrictions in Texas, 2021-2023.

Objectives. To demonstrate the spatially uneven effects of abortion restriction laws in Texas. Methods. We used network analysis to determine the change in distance to the nearest surgical abortion provider for 5253 Texas neighborhoods after the passing of Texas Senate Bill 8 (SB8; 2021) and the US Supreme Court's Dobbs v Jackson Women's Health Organization (2022) decision. We identified associations between key measures of neighborhood socioeconomic context and change in distance to providers using multivariable linear regression models. Results. After the Dobbs decision, Texas residents experienced an average change in distance to the nearest provider of 457 miles (SD = 179). Neighborhoods of concentrated disadvantage experienced the greatest increase in distance to abortion providers after SB8's passing, and neighborhoods with high levels of income inequality experienced the greatest increase in distance after the Dobbs decision. Conclusions. We document the rapidly changing abortion landscape in a highly restrictive state and show that women living in more disadvantaged and unequal areas are most affected by the increasing distance to providers. Public Health Implications. Our methods and findings will continue to be relevant in understanding the burden placed on women in areas where medical abortion has been restricted because of the Dobbs decision. (Am J Public Health. 2024;114(10):1024-1033. https://doi.org/10.2105/AJPH.2024.307652).

Abortion Return Rates and Wait Times Before and After Texas' Executive Order Banning Abortion During COVID-19.

Objectives. To assess the associations between the executive order that Texas governor Greg Abbott issued on March 22, 2020, postponing procedures deemed not immediately medically necessary, and patients' access to abortion care in Texas. Methods. We used 17 515 individual-level patient records from 13 Texas abortion facilities for matched periods in 2019 and 2020 to examine differences in return rates for abortion after completion of a state-mandated ultrasound and median wait times between ultrasound and abortion visits for those who returned. Results. Patients were less likely to return for an abortion if they had an ultrasound while the executive order was under effect (82.8%) than in the same period in 2019 (90.4%; adjusted odds ratio = 2.06; 95% confidence interval = 1.12, 3.81). Compared with patients at or before 10.0 weeks' gestation at ultrasound, patients at more than 10 weeks' gestation had higher odds of not returning for an abortion or, if they returned, experienced greater wait times between ultrasound and abortion visits. Conclusions. Texas' executive order prohibiting abortion during the COVID-19 pandemic disrupted patients' access to care and disproportionately affected patients who were past 10 weeks' gestation. (Am J Public Health. 2024;114(10):1013-1023. https://doi.org/10.2105/AJPH.2024.307747).

Evaluating participant engagement in a preconception cohort study in relation to the Dobbs decision.

BACKGROUND: On June 24th, 2022, the United States (US) Supreme Court's ruling in Dobbs v. Jackson, et al. (hereafter, the Dobbs decision) removed federal-level protections for induced abortion, sparking concerns about reproductive rights and health privacy. Although other pregnancy outcomes (e.g. spontaneous abortion, ectopic pregnancy) are not explicit targets of post-Dobbs abortion bans, study participants may be worried about how their reproductive health data are used by researchers in the post-Dobbs era. OBJECTIVE: To evaluate the extent to which the Dobbs decision influenced participant's engagement in a preconception cohort study. METHODS: We leveraged data spanning 20 weeks before and after the Dobbs decision (4 February 2022, to 11 November 2022) from US participants in Pregnancy Study Online (PRESTO), an internet-based prospective preconception cohort study of couples attempting conception. We categorised participants' state-level abortion access by residential location: banned or restricted rights; limited access; and protected rights. We evaluated three participant engagement outcomes: follow-up questionnaire completion; report of a pregnancy; and clicking on the invitation link for a fertility-tracking app. We fit separate linear regression models and restricted cubic splines to compare outcome prevalence before and after the Dobbs decision by state-level abortion category. RESULTS: A total of 585 newly enrolled participants and 1247 already-enrolled participants received 2802 invitations to complete a follow-up questionnaire. In states with limited or protected abortion rights, we observed little change in participant engagement. In states with banned or restricted abortion rights, however, we observed a 27.12 percentage point reduction (95% confidence interval -43.68, -10.51) in the prevalence of clicking on the invitation link for the fertility-tracking app comparing the post- versus pre-Dobbs periods. CONCLUSIONS: There was some evidence of reduced participant engagement after the Dobbs decision in states with banned or restricted abortion rights, indicating potentially deleterious effects on the conduct of reproductive health studies.

"We need to confirm at least from two or three": Healthcare workers' discretion as gatekeepers in the context of the Ethiopian abortion law.

INTRODUCTION: Women's access to legal and safe abortion is a vital means to reduce unsafe abortion, which in turn is known to reduce maternal morbidity and mortality. In 2005, Ethiopia enacted a relatively permissive abortion legislation. However, there is evidence that access to abortion care services may be challenging and controversial even if progressive abortion laws are in place. This article examines women's access to abortion services from the perspective of healthcare workers in a rural setting in Ethiopia. Drawing on Lipsky's theory of street-level bureaucrats, the article discusses healthcare workers' discretion and the substantial authority they hold as gatekeepers to safe abortion services. METHODS: The study draws upon a qualitative, interpretative methodological approach, with in-depth semi-structured interviews with healthcare workers as the key method of data generation. The data was analyzed and interpreted thematically. Healthcare workers' perspectives were examined with reference to the national abortion legislation and guidelines. RESULTS: The findings reveal that healthcare workers make decisions on behalf of the women who seek abortion, and they involve parents and partners in abortion-related decision-making processes. Moreover, they assess the social context of the pregnancy such as the marital and economic statuses of the abortion-seeking women in ways that restrict women's access to legally-endorsed abortion services. CONCLUSIONS: Healthcare workers' practices in this rural area were found to challenge the basic provisions laid out in Ethiopia's abortion legislation. Their negative discretion of the legislation contributes to the substantial barriers Ethiopian abortion-seeking women face in gaining access to legal abortion services, despite the presence of a progressive legal framework and guidelines.

The abortion trend after the pronatalist turn of population policies in Iran: a systematic review from 2005 to 2022.

OBJECTIVE: Given Iran's recent shift towards pronatalist population policies, concerns have arisen regarding the potential increase in abortion rates. This review study examines the trends of (medical), intentional (illegal), and spontaneous abortions in Iran over the past two decades, as well as the factors that have contributed to these trends. METHODS: This paper reviewed research articles published between 2005 and 2022 on abortion in Iran. The study employed the PRISMA checklist for systematic reviews. Articles were searched from international (Google Scholar, PubMed, Science Direct, and Web of Science) and national databases (Magiran, Medlib, SID). Once the eligibility criteria were applied, 42 records were included from the initial 349 records. RESULTS: Abortion is influenced by a variety of socioeconomic and cultural factors and the availability of family planning services. Factors that contribute to unintended pregnancy include attitudes toward abortion, knowledge about reproductive health, access to reproductive health services, and fertility desires, among others. In addition to health and medical factors, consanguineous marriage plays an important role in spontaneous and therapeutic abortion. A higher number of illegal abortions were reported by women from more privileged socioeconomic classes. In comparison, a higher number of medical and spontaneous abortions were reported by women from less privileged socioeconomic classes. CONCLUSION: Iranian policymakers are concerned about the declining fertility rate and have turned to pronatalist policies. From a demographic standpoint, this seems to be a reasonable approach. However, the new population policies, particularly, the Family Protection and Young Population Law, along with creating limitations in access to reproductive health services and prenatal screening tests as well as stricter abortion law could potentially lead to an increase in various types of abortions and their associated consequences.

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.

Abortion Education for Medical Students in an Era of Increased Abortion Restrictions.

Following the Supreme Court's decision in Dobbs v Jackson Women's Health in June 2022, many states restricted or banned abortion. Medical educators have focused on how this change impacts abortion training for residents, but schools must also adapt undergraduate medical education. Medical schools provide the foundation for future physicians' knowledge and attitudes on abortion. Comprehensive, high-quality abortion education for all medical students is essential for the future of abortion care. Here, we present how education champions can lead curricular improvements in abortion education in the preclinical, clerkship, and postclerkship phases of undergraduate medical education.

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.

Motivations for using misoprostol for abortion outside the formal healthcare system in Colombia: a qualitative study of women seeking postabortion care in Bogotá and the Coffee Axis.

BACKGROUND: In 2006, a Constitutional Court ruling partially decriminalized abortion in Colombia, allowing the procedure in cases of rape, risk to the health or life of the woman, and fetal malformations incompatible with life. Despite this less prohibitive law, some women and pregnant people preferred self-managing their abortions outside the formal healthcare system, often without accurate information. In 2018, we undertook a study to understand what motivated women to self-manage using medications that they acquired informally. Colombia has since adopted a progressive law in 2022, permitting abortion on request through the 24th week of pregnancy. However, the implementation of this law is still underway. Examining the reasons why women chose to informally self-manage an abortion after 2006 may not only highlight how barriers to legal services persisted at that time, but also could inform strategies to increase knowledge of the current abortion law and improve access to services going forward. METHODS: In-depth interviews were conducted in 2018 with 47 women aged 18 and older who used misoprostol obtained outside of health facilities to induce an abortion, and who were receiving postabortion care in two private clinics. Interviews explored what women knew about the 2006 abortion law which was then in effect, and the reasons why they preferred informal channels for abortion care over formal healthcare services. RESULTS: Women's motivations to use misoprostol obtained outside the formal healthcare system were influenced by lack of trust in the healthcare system along with incomplete and inaccurate knowledge of the abortion law. Conversely, women considered misoprostol obtained outside the healthcare system to be effective, affordable, and easier to access. CONCLUSIONS: Obtaining misoprostol outside the formal healthcare system offered a more accessible and appealing prospect for some women given fears of legal repercussion and stigma toward abortion. Though this preference will likely continue despite the more liberal abortion law, strategies should be implemented to broaden knowledge of the recent change in law and to combat misinformation and stigma. This would support knowledge of and access to legal abortion for those who wish to avail themselves of these services.

The IAPM New York 2024 declaration on professional responsibility and abortion.

The International Academy of Perinatal Medicine (IAPM) firmly supports abortion as a fundamental reproductive right, as declared at their annual meeting on June 28, 2024, in New York City. This stance, grounded in professional responsibility, respects both autonomy and beneficence-based obligations to pregnant patients and fetal patients. The IAPM asserts that access to safe, legal abortion services is essential for gender equality, public health, and social justice. Their declaration aligns with international human rights standards, advocating for abortion legalization up to fetal viability and beyond in cases of maternal health risks or severe fetal anomalies. This comprehensive approach underscores the critical role of healthcare professionals in providing compassionate reproductive healthcare, aiming to reduce maternal mortality and improve public health outcomes globally.

'We had that abortion together': abortion networks and access to il/legal abortions in Turkey.

Abortion was legalised in Turkey in 1983 with a 10-week limit, restrictions on who could provide abortions, and spousal or parental consent requirements. Currently, although abortion is legal, because of structural barriers, access is restricted (O'Neil, Altuntas, and Keskin 2020). This study aimed to investigate how women strategically mobilise their social networks to overcome such restrictions to abortion care. Drawing from 25 in-depth interviews with urban-educated cis-women aged 24-30, I identify three groups within abortion networks: included, excluded and ambiguous. While included groups comprised largely of female family and friends, excluded groups were male family members and organisations, and the ambiguous category included health professionals and partners. Supporting findings in other contexts, individuals initially utilise their abortion networks to access the provider, they then build abortion solidarity networks to act as buffers against groups they wish to exclude during the abortion experience. Additionally, I show that excluded and ambiguous networks also impact abortion access, decision-making, and experience, even pushing individuals to follow through with illegal or semi-legal abortion procedures. Findings draw attention to the structural boundaries surrounding abortion laws, how patriarchal institutions make access to abortion care and abortion networks challenging, and how social networks may be utilised to alleviate such obstacles.