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Issue briefs

Abortion

How facility standards for common outpatient procedures are developed and the implications for abortion. March 2018.

Expert respondents report that, unlike state laws that target abortion-providing facilities for regulation, facility standards for other outpatient procedures are typically set by committees of clinicians brought together by professional associations or accreditation organizations.

Turnaway Study annotated bibliography. March 2018.

The Turnaway Study is ANSIRH’s ground-breaking longitudinal study examining the effects of unintended pregnancy on women’s lives. This brief provides both an introduction to the study and an annotated bibliography.

How obtaining an abortion versus being denied one impacts alcohol, tobacco, and drug use. March 2018.

ANSIRH’s Turnaway Study found no evidence that having an abortion leads women to increase use of alcohol, tobacco, or drugs. We compared telephone interview data over the course of five years from women who received abortions and women who were denied wanted abortions. We found that having an abortion does not lead women to increase alcohol, tobacco, and drug  use and that a woman who has an abortion typically continues the same alcohol, tobacco, and drug use patterns they had prior to discovering their pregnancies. 

Cloud LK
State law approaches to facility regulation of abortion and other office interventions. February 2018.

TRAP (Targeted Regulation of Abortion Providers) laws do not bring abortion-providing facilities in line with other health care facilities, but instead subject them to different and more stringent requirements. This differential treatment suggests a lack of health benefit from TRAP laws, indicating they reduce access without justification. Legislators and policymakers seeking to protect women’s health would be better served by addressing abortion provision within the context of comparable health care services rather than via separate and different requirements.

Hebert LE
Stulberg DB
Religious hospital policies on reproductive care: What do patients want to know? January 2018.

Our analysis indicates that the vast majority of adult American women of reproductive age want information about a hospital’s religious restrictions on care when deciding where to go for ob/gyn care. Growth in the US Catholic healthcare sector suggests an increasing need for transparency about these restrictions, so that women can make informed decisions and, when needed, seek alternative providers.

Gerdts C
Glymour MA
Socioeconomic outcomes of women who receive and women who are denied wanted abortions. January 2018.
Many women are already experiencing economic hardships at the time they seek an abortion. In fact, not having enough money to care for a child or another child is the most common reason for seeking an abortion. Consistent with their concerns, we found that being denied a wanted abortion results in economic insecurity for women and their families, and an almost fourfold increase in the odds that a woman’s household income is below the Federal Poverty Level compared to those who receive an abortion.
Johns N
Meckstroth KR
Kerns JL
Distance traveled for abortion and source of care after abortion in California’s Medicaid Program. August 2017.

This is the first study to examine the relationship between distance traveled for abortion and where women seek any potential follow-up care. By analyzing data from 39,747 abortions covered by Medi-Cal, California’s Medicaid program, in 2011 and 2012, researchers found that women who traveled 100 miles or more for an abortion were more than twice as likely as women traveling 25 miles or fewer to seek any potential subsequent care at an emergency department.

Hossain A
Moseson H
Gerdts C
Biswas KK
Effects of being denied safe MR in Bangladesh. October 2016.

Many women who are denied menstrual regulation services go on to seek unsafe abortion: further study could help identify strategies to improve access to safe abortion services.

Impact of Ohio’s law mandating use of the FDA-approved protocol for medication abortion. August 2016.

In 2011, an Ohio law took effect mandating the use of an outdated Food and Drug Administration (FDA)-approved protocol for medication abortion. ANSIRH researchers found that women who had medication abortions after the law were three times more likely to require additional medical treatments to complete the abortion. The law change in Ohio restricted medical practice to a protocol that did not result in improved health outcomes for women.

Safety and effectiveness of first-trimester medication abortion in the United States. August 2016.

Since mifepristone was first approved in 2000, state legislatures have passed a number of laws that restrict access to medication abortion. Medication abortion, however, is both extremely safe and highly effective. This brief reviews research findings on medication abortion safety and effectiveness, and on guidelines for provision of medication abortion, including via telemedicine and by advanced practice clinicians.

Hajri S
Gerdts C
Baum SE
La recherche en santé reproductive: le briefing. April 2016.

Des opportunités  existent à améliorer l’accès aux services d’avortement.

Turok DK
Belusa E
Combellick S
Women’s experiences with a 72-hour waiting period for abortion. March 2016.

This brief summarizes our study in Utah on 72-hour waiting periods, which examined women’s decision-making, costs associated with each visit, actual wait times between the information visit and the abortion, and, through follow-up interviews, captures the voices of some of the 500 women who took part in the study identifying the hardest part of waiting and of making two visits.

Harries J
Momberg M
Gerdts C
Denial of legal abortion in South Africa. March 2016.

Many women who are denied legal abortion care go on to seek unsafe alternatives: further study could help identify strategies to improve access to safe abortion services in South Africa.

Puri M
Vohra D
Gerdts C
Effects of being denied legal abortion in Nepal. November 2015.

Many women who are denied legal abortion care go on to seek unsafe alternatives: further study could help identify strategies to improve access to safe abortion services in Nepal.

Safety of abortion in the United States. December 2014.

Using billing data from California's state Medicaid program, ANSIRH researchers were able to analyze data for nearly 55,000 abortions, including all health care for up to six weeks after the abortion at any clinical site, including emergency rooms and hospitals. The results indicate that abortion is extremely safe, with less than a third the complications of wisdom tooth extraction. 

What do we know about women who get later abortions? July 2014.

This brief summarizes data on who seeks later abortions and why, as well as the the causes of delay in seeking an abortion. It draws on research conducted by ANSIRH in 2013 and provides a bibliography of other research.

Contraception

Ultrasound viewing in abortion care. June 2014.

In recent years, a number of states have enacted regulations mandating specific ultrasound procedures before abortion. ANSIRH conducted a variety of studies to better understand the use and experience of ultrasound viewing in the abortion care setting. They found that many patients do want to view their ultrasound image and that they have a variety of emotional responses—but that the vast majority proceed to termination whether they view the ultrasound or not.

Interest in the pericoital pill. July 2011.

This short brief summarizes preliminary data from interviewing women in family planning clinics about their interest in the pericoital pill. The take-home message is that there is a large demand for the pill, but many women will be unable to access it unless it is available without a prescription.

International

Hossain A
Moseson H
Gerdts C
Biswas KK
Effects of being denied safe MR in Bangladesh. October 2016.

Many women who are denied menstrual regulation services go on to seek unsafe abortion: further study could help identify strategies to improve access to safe abortion services.

Hajri S
Gerdts C
Baum SE
La recherche en santé reproductive: le briefing. April 2016.

Des opportunités  existent à améliorer l’accès aux services d’avortement.

Harries J
Momberg M
Gerdts C
Denial of legal abortion in South Africa. March 2016.

Many women who are denied legal abortion care go on to seek unsafe alternatives: further study could help identify strategies to improve access to safe abortion services in South Africa.

Puri M
Vohra D
Gerdts C
Effects of being denied legal abortion in Nepal. November 2015.

Many women who are denied legal abortion care go on to seek unsafe alternatives: further study could help identify strategies to improve access to safe abortion services in Nepal.

Policy

How facility standards for common outpatient procedures are developed and the implications for abortion. March 2018.

Expert respondents report that, unlike state laws that target abortion-providing facilities for regulation, facility standards for other outpatient procedures are typically set by committees of clinicians brought together by professional associations or accreditation organizations.

Cloud LK
State law approaches to facility regulation of abortion and other office interventions. February 2018.

TRAP (Targeted Regulation of Abortion Providers) laws do not bring abortion-providing facilities in line with other health care facilities, but instead subject them to different and more stringent requirements. This differential treatment suggests a lack of health benefit from TRAP laws, indicating they reduce access without justification. Legislators and policymakers seeking to protect women’s health would be better served by addressing abortion provision within the context of comparable health care services rather than via separate and different requirements.

Hebert LE
Stulberg DB
Religious hospital policies on reproductive care: What do patients want to know? January 2018.

Our analysis indicates that the vast majority of adult American women of reproductive age want information about a hospital’s religious restrictions on care when deciding where to go for ob/gyn care. Growth in the US Catholic healthcare sector suggests an increasing need for transparency about these restrictions, so that women can make informed decisions and, when needed, seek alternative providers.

Gerdts C
Glymour MA
Socioeconomic outcomes of women who receive and women who are denied wanted abortions. January 2018.
Many women are already experiencing economic hardships at the time they seek an abortion. In fact, not having enough money to care for a child or another child is the most common reason for seeking an abortion. Consistent with their concerns, we found that being denied a wanted abortion results in economic insecurity for women and their families, and an almost fourfold increase in the odds that a woman’s household income is below the Federal Poverty Level compared to those who receive an abortion.
Nicholson WK
Sabota M
Urman RD
A systematic review of the effect of facility characteristics on patient outcomes for procedures in outpatient settings. January 2018.

While abortion has a well-documented patient safety record, an increasing number of states have enacted laws that impose specific requirements for facilities in which abortions are performed. This brief presents results from a systematic review of existing research on the effect of facility requirements on patient outcomes across outpatient procedures, including abortion. Researchers find no evidence to suggest that requiring that abortions be performed in specific types of facilities increases patient safety or improves patient experience, and may instead have an adverse effect, limiting the availability of abortion services.

Johns N
Edwards A
Soyemi A
Assessing barriers to medication abortion among California’s public university students . December 2017.

“Assessing Barriers to Medication Abortion among California’s Public University Students” presents findings regarding the barriers for students accessing medication abortion off campus, including travel distance, wait times, and financial constraints. This report also estimates the number of medication abortions each student health center could expect based on national abortion statistics adjusted for age-specific and California-specific abortion rates. The authors estimate that each UC campus, on average, would have 10-17 medication abortions per month and each CSU campus, on average, would have 9-15 medication abortions per month.

Evaluating University of California (UC) and California State University (CSU) capacity to provide medication abortion. December 2017.

"Evaluating University of California (UC) and California State University (CSU) Capacity to Provide Medication Abortion” presents findings on what would be needed for public university student health centers to safely provide medication abortion. The brief concludes that "with additional investment of staff training, equipment, 24-hour nurse hotline, back up specialty care, and security upgrades (in some cases)” the student health centers will be able to medication abortion services.

Johns N
Meckstroth KR
Kerns JL
Distance traveled for abortion and source of care after abortion in California’s Medicaid Program. August 2017.

This is the first study to examine the relationship between distance traveled for abortion and where women seek any potential follow-up care. By analyzing data from 39,747 abortions covered by Medi-Cal, California’s Medicaid program, in 2011 and 2012, researchers found that women who traveled 100 miles or more for an abortion were more than twice as likely as women traveling 25 miles or fewer to seek any potential subsequent care at an emergency department.

Impact of Ohio’s law mandating use of the FDA-approved protocol for medication abortion. August 2016.

In 2011, an Ohio law took effect mandating the use of an outdated Food and Drug Administration (FDA)-approved protocol for medication abortion. ANSIRH researchers found that women who had medication abortions after the law were three times more likely to require additional medical treatments to complete the abortion. The law change in Ohio restricted medical practice to a protocol that did not result in improved health outcomes for women.

Safety and effectiveness of first-trimester medication abortion in the United States. August 2016.

Since mifepristone was first approved in 2000, state legislatures have passed a number of laws that restrict access to medication abortion. Medication abortion, however, is both extremely safe and highly effective. This brief reviews research findings on medication abortion safety and effectiveness, and on guidelines for provision of medication abortion, including via telemedicine and by advanced practice clinicians.

Turok DK
Belusa E
Combellick S
Women’s experiences with a 72-hour waiting period for abortion. March 2016.

This brief summarizes our study in Utah on 72-hour waiting periods, which examined women’s decision-making, costs associated with each visit, actual wait times between the information visit and the abortion, and, through follow-up interviews, captures the voices of some of the 500 women who took part in the study identifying the hardest part of waiting and of making two visits.

Safety of abortion in the United States. December 2014.

Using billing data from California's state Medicaid program, ANSIRH researchers were able to analyze data for nearly 55,000 abortions, including all health care for up to six weeks after the abortion at any clinical site, including emergency rooms and hospitals. The results indicate that abortion is extremely safe, with less than a third the complications of wisdom tooth extraction. 

Religious restrictions and reproductive health. June 2014.

Over the past decade, Catholic hospitals have merged with and purchased nonsectarian hospitals around the United States, becoming leading players in the nation’s health care industry. Catholic hospitals receive billions of taxpayer dollars each year and have a combined gross patient revenue of $213.7 billion. The standards of medical care put forth in the Ethical and Religious Directives for Catholic Health Care Services not only restrict choices about abortion and contraception, but reduce access to evidence-based reproductive health services as a whole. This brief explains how.

Turnaway

Turnaway Study annotated bibliography. March 2018.

The Turnaway Study is ANSIRH’s ground-breaking longitudinal study examining the effects of unintended pregnancy on women’s lives. This brief provides both an introduction to the study and an annotated bibliography.

How obtaining an abortion versus being denied one impacts alcohol, tobacco, and drug use. March 2018.

ANSIRH’s Turnaway Study found no evidence that having an abortion leads women to increase use of alcohol, tobacco, or drugs. We compared telephone interview data over the course of five years from women who received abortions and women who were denied wanted abortions. We found that having an abortion does not lead women to increase alcohol, tobacco, and drug  use and that a woman who has an abortion typically continues the same alcohol, tobacco, and drug use patterns they had prior to discovering their pregnancies. 

Hossain A
Moseson H
Gerdts C
Biswas KK
Effects of being denied safe MR in Bangladesh. October 2016.

Many women who are denied menstrual regulation services go on to seek unsafe abortion: further study could help identify strategies to improve access to safe abortion services.

Hajri S
Gerdts C
Baum SE
La recherche en santé reproductive: le briefing. April 2016.

Des opportunités  existent à améliorer l’accès aux services d’avortement.

Harries J
Momberg M
Gerdts C
Denial of legal abortion in South Africa. March 2016.

Many women who are denied legal abortion care go on to seek unsafe alternatives: further study could help identify strategies to improve access to safe abortion services in South Africa.

Puri M
Vohra D
Gerdts C
Effects of being denied legal abortion in Nepal. November 2015.

Many women who are denied legal abortion care go on to seek unsafe alternatives: further study could help identify strategies to improve access to safe abortion services in Nepal.

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ANSIRH is a program within the UCSF Bixby Center for Global Reproductive Health and is a part of UCSF's Department of Obstetrics, Gynecology & Reproductive Sciences.

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