Abortion Clinic Access Research Paper
Abortion Clinic Access Research Paper Abortion Clinic Access Research Paper Missouris only abortion clinic expects to be shut down this week after the state health department refused to renew its license, which would make it the only US state without a legal abortion clinic, Planned Parenthood said on Tuesday. This is not a drill, said Dr Leana Wen, president and CEO of Planned Parenthood Federation of America, which runs the clinic. This is not a warning. This is real and its a public health crisis, she added. More than a million women of reproductive age in Missouri will no longer have access to a health centre in the state they live in that provides abortion care. Planned Parenthood said in a statement that the clinic would sue the state health department to preserve access to legal abortions in the state.Abortion Clinic Access Research Paper The Missouri Department of Health and Senior Services did not immediately respond to a request for comment. Missouri abortion ban On Friday, Missouri Governor Mike Parson signed a bill into law that bans abortion after eight weeks of pregnancy. READ MORE Rights groups file lawsuit to block Alabamas new abortion ban Missouri was one of several states that have passed anti-abortion legislation this year in an effort to provoke the US Supreme Court to overturn Roe v Wade, the landmark 1973 case that established a womans right to terminate her pregnancy. According to the Guttmacher Institute, a reproductive health research and policy organisation, nearly 380 abortion restrictions were introduced across the country between January 1 and May 20. About 40 percent of the proposals have been abortion bans. The Guttmacher Institute has also found that 17 bans have been enacted across 10 states so far this year. It is not unusual to see hundreds of abortion restrictions introduced every year, but this high proportion of proposed bans is unprecedented, signaling a substantial shift in tactics at the state level, the organisation recently said on its website. Supreme Court avoids abortion question Separately on Tuesday, the US Supreme Court sent a mixed message on abortion, refusing to consider reinstating Indianas ban on abortions performed because of fetal disability or the sex or race of the foetus while upholding the states requirement that foetal remains be buried or cremated after the procedure is done.Abortion Clinic Access Research Paper Both provisions were part of a Republican-backed 2016 law signed by Vice President Mike Pence when he was Indianas governor. READ MORE Stop the bans: Abortion rights activists rally across the US In an unsigned ruling, with two of the nine-member courts liberals dissenting, the Supreme Court decided that a lower court was wrong to conclude that Indianas foetal burial provision, which imposed new requirements on abortion clinics, had no legitimate purpose. The court has a 5-4 conservative majority. Although the foetal burial provision was not a direct challenge to the Roe v Wade decision, the ruling gave anti-abortion proponents a victory at the Supreme Court. But the court also indicated a reluctance to directly tackle the abortion issue, at least for now, rejecting Indianas separate attempt to reinstate its ban on abortions performed because of foetal disability or the sex or race of the foetus. The court left in place the part of an appeals court ruling that struck down that the provision. Which US states have recently passed abortion bans? While this ruling is limited, the law is part of a larger trend of state laws designed to stigmatise and drive abortion care out of reach. Whether its a total ban or a law designed to shut down clinics, politicians are lining up to decimate access to abortion, said Jennifer Dalven, a lawyer with the American Civil Liberties Union, which was part of the legal challenge to the Indiana la Most research about experiences considering and seeking abortion comes from women presenting at abortion clinics. This study examines experiences among women presenting at prenatal care. Five hundred eighty-nine women were recruited at their first prenatal visit in Southern Louisiana and Baltimore, Maryland. Participants completed self-administered iPad surveys and in-clinic structured interviews. Participants were asked if they had considered abortion for this pregnancy and, if so, reasons they did not obtain one. Twenty-eight percent of Louisiana and 34% of Maryland participants had considered abortion. Ten percent in Louisiana and 13% in Maryland had called an abortion clinic; 2% in Louisiana and 3% in Maryland had visited an abortion clinic. The most common reason for not having an abortion related to womens own decision-making, i.e. their personal preferences. Policy-related reasons were less common; but more participants who had considered abortion in Louisiana than Maryland reported a policy-related reason (primarily lack of funding for the abortion) as a reason (22% Louisiana, 2% Maryland, p?0.001). Recruiting in prenatal care is a feasible way to find women who considered, but did not obtain, an abortion for their current pregnancy. Womens own preferences were the primary reason for not obtaining an abortion across settings, but more in Louisiana than Maryland faced policy-related barriers to abortion.Abortion Clinic Access Research Paper Induced abortion allows women to control their fertility, and ensuring that all women in the USA have access to abortion is a public health goal.1, 2 In 2011, 2·8 million (45%) of the 6·1 million pregnancies in the USA were unintended, and 42% of unintended pregnancies ended in abortion.3 However, abortion is not always easy to access in the USA, and issues such as stigma, restrictive laws, and financial constraints can pose barriers to access. One key measure of access is how far women have to travel to reach an abortion clinic. Previous research4, 5, 6, 7 found that the further a woman lives from a provider, the less likely she is to obtain an abortion. Most patients seeking an abortion have limited financial resources, so having to cover the cost of travel (which can include overnight stays and time off work) might prevent them from having an abortion.8 Spatial inequalityunequal access to resources and services based on locationaffects access to abortion in many countries where it is legal.9 Studies10, 11, 12, 13 in Australia, New Zealand, Canada, and the USA have found that, among women who have abortions, those who live in rural areas typically travel greater distances than those who live in urban areas, at least in part because of subnational variation in restrictive laws.13 At least 20 US states have adopted one or more abortion restrictions since 2011 (appendix), making analysis of spatial inequality in that country particularly timely and relevant.14 In 2008, patients in the USA travelled a median distance of 15 miles (24 km) to have an abortion.15 Although the median distance travelled was reasonably low, a substantial minority of women (17%) travelled 50 miles (80 km) or more, and 31% of women living in rural areas travelled 100 miles (161 km) or more to have an abortion. A 2016 study16 examined the change in how far women travelled for an abortion in the state of Texas after implementation of a restrictive law, which resulted in the closure of 22 (54%) of 41 abortion providers in the state. Similar to women nationally, patients in Texas in 2013 travelled a mean distance of 15 miles (24 km) to reach an abortion facility. The mean distance increased by 20 miles (32 km), to 35 miles (56 km), in 2014 after the law came into effect, and the number of patients who travelled more than 50 miles (80 km) increased from 10% to 44%.16 A limitation of those analyses was that they examined users of abortion services and did not capture women who wanted abortions but did not make it to the clinic because of distance; thus, they did not fully capture spatial inequality in access to abortions.4, 5, 6, 7 Two studies4, 7 found that the number of abortions in a county in Texas decreased as the distance to the nearest abortion facility increased between 2012 and 2014. Previous studies5, 6 that used abortion data for the states of New York and Georgia in the 1970s also found that the further women lived from a county or state where abortion care was provided, the lower the abortion incidence. These studies suggest that distance has been a persistent barrier to abortion. Between 2011 and 2014, abortion incidence in the USA decreased by 14% to 14·6 abortions per 1000 women (1544 years) each year.17 During the same period, the number of clinics providing abortions decreased by 6%, from 839 to 788, compared with a 1% decline across the preceding 3 year period.17 The decline in clinics was greatest in the midwest (22%) and southern (13%) regions, which also had the highest number of abortion restrictions enacted over this period.17 As abortion clinics closed and service availability shifted, women might have had to travel further to have an abortion. Using abortion-clinic data for 2014, 2011, and 2000, we examined spatial disparities in distance to the nearest abortion clinic by state and county. Because a decline in the number of abortion clinics might have increased the distance women had to travel to reach a provider,17 we also examined state-specific and county-specific changes in distance to abortion clinics between 2011 and 2014. In a supplementary analysis to assess the long-term stability of access to abortion, we also analysed change since 2000.Abortion Clinic Access Research Paper We obtained the location of all abortion clinics in the USA from the Guttmacher Institutes Abortion Provider Census (APC). Since 1973, the Guttmacher Institute has regularly surveyed all known abortion-providing facilities to collect information about number of abortions and other aspects of service provision. The APC provides the most accurate counts of abortion available in the USA.18 In the most recent APC, information was collected for 2014.17 We also used data for 2011 and 2000 in this analysis. Approval for the study was obtained through expedited review by the Guttmacher Institutes federally registered institutional review board. To identify clinics providing abortion services to the public, we limited the analysis to facilities that had caseloads of 400 abortions or more per year and those affiliated with Planned Parenthood that did at least one abortion in the period of interest. We included Planned Parenthood facilities that provided fewer than 400 abortions in a year because of name recognition and because their websites indicated whether they provided abortion services. These providers did 95% of all abortions in 2014; of the remainder, 2·1% occurred in hospitals, 1·4% in private physicians offices, and 1·5% in health clinics. Not all locations where abortions are done are accessible and discoverable to a woman seeking abortion care. Abortion providers in the USA have been targets of domestic terrorism, and doctors might be unable to maintain a practice if they are known to be willing to do abortions. Our data collection efforts showed that facilities doing small numbers of abortions seldom advertise their services. Thus, it is possible for a woman to live near to an abortion provider without knowing of that physician or that the physician provides abortions. Such a provider would not constitute a public point of access, and these were excluded from our analysis. Moreover, confidentiality concerns did not allow us to reveal the locations of low-volume providers because doing so would threaten their safety.Abortion Clinic Access Research Paper Statistical analysis To measure the distance between women and abortion providers, we first needed to specify the location of both. For women, we used the smallest publicly available geographical units, census block groups, which are geographical subdivisions of census tracts.19 For their coordinates, we used population-weighted centroids.20 For abortion providers, we geocoded (ie, determined the latitude and longitude of) each provider using Maptitude 2016, and linked each census block group to the nearest provider. Some women obtain abortions outside their state of residence; as such, in our analysis the nearest provider could be in another county or state. We used Open Source Routing Machine 4.9 to compute driving distance.21 To estimate mean and percentile distances for each state and county, we weighted each block group by the approximate number of women of reproductive age (1544 years). We obtained population data for 2000 and 2010 from the Decennial Census.22, 23 The smallest geographical area for which age and sex distributions were available was census tract; therefore, we multiplied each block groups population by the proportion of the census tract that was made up of women aged 1544 years. To account for population growth after 2010, the last year a census was done, we scaled each block groups population using the Census Bureaus 2011 and 2014 county population estimates.24 Mean distances were right skewed by the small proportion of women who lived several 100 miles from the nearest provider. For this reason, we used median distance or the value for which half of women in a county lived from the nearest provider. In our state-level analyses, we also examined 80th percentile distances. We analysed whether distance to provider varied by the National Center for Health Statistics urban-rural classification scheme, an extension of the Office of Management and Budget metropolitan statistical area (MSA) classification.25 No smooth gradient was seen in the number of abortions done by providers; of the providers excluded from the analysis in 2014, 631 (62%) did fewer than 25 abortions, whereas 38 (4%) did 300399 abortions. A concern was that a small number of abortions might have placed a provider above or below 400 abortions so as to substantively affect our results. To address this possibility, we did a sensitivity analysis that included all providers who did at least 200 abortions. Another concern was that rural areas might have been served by providers who did very few abortions. However, although 43% of counties were rural, less than 1% of the excluded providers were in rural areas. All of these were either hospitals or physicians offices, except for one clinic, which did not advertise abortion services on its website.Abortion Clinic Access Research Paper We excluded the District of Columbia from the tables and discussion of the findings (but not from the overall analysis) because it is not a state. In both 2011 and 2014, the District of Columbia had four or more abortion clinics,17, 26 and residents would have had to travel a median distance of 2 miles to reach the nearest clinic (shorter than the median distance in any state). Role of the funding source The funding source did not have any role in the study design, data collection, data analysis, writing of the manuscript, or in the decision to submit the paper for publication. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. Facing an uplanned pregnancy is hard. No one should have to go through it alone. If you have questions about parenting, adoption, or abortion, we are here to give you the support you need. Our services for birthmothers are always confidential and completely free. You can be connected to a CHI social worker seven days a week during or after office hours via phone at 559.229.9862, text 559.905.1000, or email. A social worker is also available to meet with you at our office, at your residence, or at a neutral location where you would be comfortable. At Chrysalis House, we believe that you deserve to be treated with dignity and respect, and we do our best to make sure you feel supported during this process. Some of our services include: Permalink: https://nursingpaperessays.com/ abortion-clinic- s-research-paper / Helping you determine if adoption is right for you with no obligation to complete an adoption plan Advising you about your rights and options Exploring open adoption and if it is right for you Helping you choose and meet an adoptive family Assisting with financial needs Corresponding with birthfather, if necessary Emotional support during and after pregnancy Access to abortion is a key component of womens comprehensive health care. The ability to choose if, when, and how to give birth is linked to womens economic success, educational attainment, and general health and well-being.Abortion Clinic Access Research Paper Anti-choice advocates, unfortunately, often use womens health and maternal mortality as justifications for abortion restrictions.2 Although abortion has been proven to be one of the safest medical procedures, anti-choice policymakers at state and federal levels continue to use the guise of protecting womens health to promote restrictions on abortion providers and procedures such as medication abortion; add requirements for women to fulfill in order to receive an abortion; and limit the procedure after an arbitrary number of weeks into a pregnancy.3 Research shows, however, an inverse relationship between abortion restrictions and both maternal and child health outcomes and the number of policies intended to support women and childrens well-being, including Medicaid expansion and protections for pregnant workers, among others.4 Additionally, persistent structural racism plays a significant role in the connection between abortion restrictions and maternal mortality. State and federal abortion restrictions and maternal mortality rates are on the rise. Between 2010 and 2015, states enacted more abortion restrictions than during any other five-year period since Roe v. Wade in 1973.5 The maternal mortality rate in the United States grew by 136 percent in the years between 1990 and 2013.6 This connection is no coincidence: Restrictions on womens health careincluding abortioncan have devastating impacts on womens health. Although the anti-choice movement continues to posit abortion as dangerous for women, the procedure should be uplifted as what it often really islife-saving, affirming, and integral to womens health. States with more abortion restrictions have higher rates of maternal and infant mortality Abortion restrictionsespecially gestational bans, which seek to ban abortion at an arbitrary point of gestation during pregnancyare often proposed by anti-choice lawmakers as a way to protect womens health. However, research has shown that the more abortion restrictions a state has, the worse women and childrens health outcomes in the state are. The Center for Reproductive Rights (CRR) conducted a study that created a state-level scoring system with the following categories: abortion restrictions; policies that support women and childrens well-being; women and childrens health outcomes ; and social determinants of health.7 The study used indicators such as parental involvement in and waiting periods for abortion, as well as expanded Medicaid and the existence of a maternal mortality review board.8 Ultimately, researchers found an inverse relationship between abortion restrictions and women and childrens health outcomes as well as the number of evidence-based policies passed to support women and childrens well-being. South Carolina, for example, has 14 abortion restrictionsone of every type identified by the studyand also some of the worst outcomes for womens health in the country. In 2015, one-third of South Carolina had no dedicated health care provider, plus maternal mortality rates had risen 300 percent.9 This study shows that womens health and well-being is a talking point the anti-choice movement wields in their favorrather than a legitimate goal. If such individuals were genuinely invested in improving maternity outcomes, they would prioritize access to health care, Medicaid expansion, paid family and medical leave, affordable child care, and other public policies that support maternal health. They would also ensure access to safe, affordable abortion and contraception so that women can choose when and if to have a child. The CRR study indicates that the lack of these investments in the anti-choice movements priorities shows the movement is more interested in controlling womens bodies than in supporting their reproductive decision-making and overall health.Abortion Clinic Access Research Paper Racism contributes to poor health outcomes for women of color It is crucial to examine the extent to which racism worsens maternal and infant mortality. Communities of color, and primarily African Americans, are disproportionately affected by limitations to abortion and experience elevated rates of maternal and infant mortality compared with non-Hispanic white mothers.10 Indeed, racism is a motivating factor behind legislation that seeks to strip autonomy from women of color and limit their reproductive decision-making; restrictions on abortion and contraception disproportionately impact women of color, and anti-choice proponents intentionally target communities of color in their advocacy and outreach.11 Furthermore, racism can sometimes fuel neglect within the medical industry: Health care providers have been known to ignore the pain of women of color, which contributes toward preventable death, maternal mortality, and distrust of health care providers. Additionally, women of colorin particular, black womenexperience higher levels of stress and discrimination compared with non-Hispanic white women across all age levels, which contributes to lower health outcomes and increased maternal mortality.12 The ways in which women of color are discriminated against and excluded from the health care system provide insight into how reduced access to abortion may contribute to high rates of maternal mortality.13 Abortion restrictions can lead to unsafe abortions Limiting abortion through various restrictionssuch as waiting periods, mandatory ultrasounds, and parental consenthas been shown to increase rates of unsafe abortion rather than eliminate the need for abortion.14 Limitations place women in desperate situations, and some may attempt to have abortions through unsafe methods as a result. When the United States legalized abortion in 1973, pregnancy-related deaths and hospitalizations due to complications of unsafe abortions reduced significantly.15 The number of abortion-related deaths fell from 40 deaths per one million live births in 1970 to eight deaths per one million in 1976. After 1975, mortality due to legally induced abortion fell from three deaths per 100,000 abortions in 1975 to about one death per 100,000 abortions in 1976.16 Unsafe abortion is uncommon in the United States, but with the increase in policies that restrict access to reproductive health careincluding state-based abortion restrictions, the restructure of Title X family planning clinics to distribute more funding toward crisis pregnancy centers rather than clinics that provide comprehensive information, and policies that reduce access to affordable contraceptionthere is a chance that the number of abortion-related deaths may rise.17 State-based abortion restrictions have grown in the 45 years since Roe v. Wade and have potentially contributed toward rising maternal mortality rates.18 For instance, in Texas, the rate of maternal deaths rose from 72 deaths per 100,000 live births in 2010 to 148 deaths per 100,000 live births in 2012.19 Reproductive health experts linked the uptake in maternal deaths to state-based limitations on abortion and reproductive health fundingincluding cuts to family planning services and a defunding of Planned Parenthoodthat occurred during the same window of time.20 Planned Parenthood and other family planning clinics often serve as a gateway into the health care systemproviding health care and referrals for patients that may not otherwise have a regular provider. Thus, it is plausible that the unmet need for abortion and family planning servicessuch as cancer screenings and STI testing and treatmentthat resulted from restrictions on funding led to increased maternal mortality in Texas.Abortion Clinic Access Research Paper Barriers to abortion access may delay critical prenatal care In the case of an unintended pregnancy, the restrictions and barriers women face in pursuit of an abortion can result in stress and delay of critical prenatal care, further contributing to maternal mortality rates. Unintended pregnancy in the United States has declined slightly over the past few years51 percent of pregnancies were unintended between 2006 and 2010, while 45 percent were unintended in between 2009 and 2013.21 Increased access to contraception has been cited as at least partially responsible for this decline.22 However, these rates are still high compared with those of other developed countries and, importantly, vary disproportionately by race. In 2011, the unintended pregnancy rate for black women was more than double that of non-Hispanic white women.23 While increased access to contraception may have helped improve the average unintended pregnancy rate, communities of color still experience significant barriers to contraception and abortionincluding cost and geographic limitationsthat could decrease maternal mortality rates. Many unintended pregnancies end in abortion, and those that do not often result in poor health outcomes for both mother and child.24 Unintended births are linked to negative physical and mental health outcomes for children compared with intended births. Women who experience unintended pregnancy and are forced to carry the pregnancy to term are likely to delay the initiation of prenatal care, which can result in higher incidences of maternity-related health problems.Abortion Clinic Access Research Paper From 20082011, there was a slight increase in the share of unintended pregnancies that ended in abortion.26 However, there are still restrictions on abortion that can impact maternal and child health and well-being. Abortion restrictions vary by state and can require significant amounts of time, money, and other resources to acquireespecially depending on how far along a pregnancy is.27 If a pregnancy is unintended, overcoming hurdles to obtaining an abortionsuch as travelling hundreds of miles for a procedure, missing multiple days of work because of mandatory waiting periods, lack of access to child care for women who are already mothers, or fundraising as the cost of the procedure risescan create negative stress for maternal and child health.28 This stress can take a significant toll on the health and well-being of children if the woman pursuing the abortion is already a motherand about 60 percent of women who get abortions are.29 Additionally, the restrictions placed on abortion can prolong the process indefinitely. If the outcome of the pregnancy in this situation is birth rather than abortion, then the child and mother may be predisposed to negative health outcomes as a result of delayed prenatal care. Finally, delays in accessing care can move women to consider unsafe abortion methods. In one study, women considered self-induced abortion using unsafe methods such as blunt-force trauma as a result of frustration with delays in accessing safe abortion.30 Access to comprehensive reproductive health careincluding safe and legal abortionis critical to promoting better maternal and infant health outcomes. Research suggests the delays, costs, and complications that result from barriers to abortion access could be contributing to poor maternal health outcomesand even deathcontrary to messaging from anti-choice proponents. Proactive measures, including improving access to abortion and other critical womens health care services, must be taken in order to help address the maternal mortality crisis. A womens right to choose abortion should be key to strengthening maternal and child health.Abortion Clinic Access Research Paper Womens ability to determine if and when they get pregnant and continue that pregnancy is key to their overall well-being. Women who are denied wanted abortions experience some negative outcomes compared with women who were able to obtain abortions, including increased economic insecurity [1] and continued exposure to violence from the man involved in the pregnancy [2]. While abortion rates have declined slightly in recent years, over 926,000 abortions were performed in the United States in 2014 [3]. This rate is equivalent to 1 in 4 women of reproductive age having an abortion within her lifetime [3], which underscores that abortion is common. The explanations for the decline in abortion rates are varied, but part of this drop can likely be attributed to the decrease in facilities at which women can obtain abortion care across the United States over the past decade. Most abortions (95%) are performed in specialized abortion clinics (rather than private physicians offices or hospitals), and the number of these clinics declined in half of US states from 2011 to 2014, with some regions experiencing up to a 22% decrease [3]. Because 90% of US counties do not have an abortion provider [3], many women seeking abortion must travel outside their home counties to obtain care. Other geographic disparities have been documented: women living in rural areas, the South and Midwest regions of the United States, and those seeking second-trimester or later abortions are more likely to travel farther for services, often 50 miles (80 km) or more one way [4-7]. These shifts in the availability of abortion-providing facilities indicate that women in underserved areas must travel increasingly far for abortion care.Abortion Clinic Access Research Paper Somedecline in the number of abortion facilities may be due to the more than 400 state laws regulating abortion that have been adopted between 2011 and 2017 [8], which, among other requirements, mandate that physicians have local hospital admitting privileges, facilities have formal transfer agreements with local hospitals, and facilities become ambulatory surgical centers. These laws have likely led to the closure of facilities that could not meet the financial or administrative requirements imposed by these laws. For example, after these types of laws were passed in Texas in 2013, the number of abortion facilities decreased by 54% over 15 months, requiring women whose nearest clinic had closed to travel 85 miles (137 km) one way to a facility [9]. Additional analyses of trends in abortion rates in Texas from 2012 to 2014 found a relationship between increases in distance to the nearest abortion facility and decreases in the county abortion rate [10]. Another analysis from Louisiana estimated that, if admitting privileges laws were to go into effect, 67% of women of reproductive age would live more than 150 miles (241 km) from the nearest abortion facility, thereby tripling the distance women have to travel to reach the nearest facility for care [11,12]. With distance come increased travel time, increased costs for transportation and childcare, lost wages, the need to take time off of work or school, the need to disclose the abortion to more people than desired, and overall delays in care [13-15]. Ultimately, delays in reaching and obtaining care can push women later into their pregnancies, even up to the point that they might not be able to obtain a wanted abortion, depending on the gestational limits on abortion in their state [16]. To obtain abortion care in their communities, women who do not know where to go may use the internet to find abortion facility information [15]. Almost half (45%) of women seeking abortion services at clinics in Nebraska located the abortion clinic through an online search [17], and a recent study documented an interest in information on self-abortion among people searching online using the search engine Google [18]. Online searching for abortion information appears to be more prevalent in states with restrictive abortion laws and where abortion availability is limited, suggesting that women with reduced access to abortion are more likely to seek out information on abortion online [19,20].Abortion Clinic Access Research Paper We were interested in examining the question What does the current landscape of abortion facilities look like to women searching online for abortion services? There are no publicly available systematically documented and comprehensive lists of US aborti