Abstract
Objective
To assess the accuracy of knowledge of state-level abortion laws and regulations among clinicians who provide reproductive health care.
Methods
Members of several reproductive health professional organizations completed a self-administered survey. Respondents were asked if laws and regulations were present in their state. Responses were graded according to the Guttmacher Institute's monthly publication State Policies in Brief: An Overview of Abortion Laws.
Results
Three hundred forty-one surveys were completed. Fifty-nine respondents met exclusion criteria and were excluded. Of the remaining 282, most (80.1%) were physicians, and over half (55.0%) reported currently providing abortion services. Most (86.5%) considered themselves to be informed about abortion laws and regulations in their state. Knowledge of laws and regulations involving spousal involvement, mandatory waiting periods, and availability of private insurance coverage was high (77.0%–86.2%). Receiving reminders of state abortion laws and regulations was associated with significantly more accurate knowledge of parental notification and spousal consent laws, mandatory waiting periods, and availability of Medicaid and private insurance coverage (all p < .05). Receiving reminders and being a provider of abortion services were independent predictors of better knowledge of state abortion laws and regulations among clinicians who provide reproductive health care.
Conclusion
Clinicians who provide reproductive health care had highly accurate knowledge of some abortion laws and regulations, but less accurate knowledge of others. Reminders of laws and regulations may increase knowledge among clinicians. Given the importance of accurate information, evaluation of mechanisms to increase knowledge of abortion laws and regulations may be warranted.
Introduction
An estimated 1.2 million abortions were performed in the United States in 2008, and the incidence seems to have stabilized after more than a decade of decline (
Jones and Kooistra, 2011
). The controversy surrounding induced abortion in the United States is evident in the record number of abortion restrictions recently enacted by state legislatures (135 in 2011; Guttmacher Institute, 2012
)Guttmacher Institute (2012). States enact record number of abortion restrictions in 2011. Available: http://www.guttmacher.org/media/inthenews/2012/01/05/endofyear.html
Restrictions on abortion services take a range of forms. As of June 1, 2013, 39 states require that abortions be performed by a licensed physician. Forty-six states allow individual health care providers to refuse to participate in abortion provision, and institutions are allowed to refuse in 43 states, 16 of which limit this practice to private or religious institutions. Thirty-eight states require parental consent and/or notification for a minor to obtain an abortion. Based on the decisions in
Planned Parenthood v. Danforth, 1975
and Planned Parenthood v. Casey, 1993
, no state can require spousal consent or notification for a married woman to obtain an abortion, because it was deemed unconstitutional. Twenty-six states mandate a waiting period, ranging from 24 to 72 hours, from the time of counseling to the procedure. Forty-one states prohibit abortions after a specified point in pregnancy, which is often the point of fetal viability, although abortion is generally allowed after this point when necessary to protect the woman's life or health. Seventeen states mandate that patients seeking abortion services be counseled before an abortion on issues such as the purported link between abortion and breast cancer (Beral et al., 2004
), the fetus's ability to feel pain (Lee et al., 2005
), and long-term mental health consequences for the woman (Charles et al., 2008
). Thirty-three states prohibit the use of state funding for abortion, and 8 states restrict abortion coverage by private insurance plans. Finally, 19 states prohibit so-called “partial-birth” abortion (Guttmacher Institute, 2013
).Guttmacher Institute (2013). State policies in brief: An overview of abortion laws. Accessed 2013 from: http://www.guttmacher.org/statecenter/spibs/spib_OAL.pdf
The increase in abortion-related laws and regulations affects clinicians who provide women's health care regardless of whether they provide abortion services, given that most are likely to encounter women seeking abortion services. Although obstetrician-gynecologists are not the only clinicians who provide reproductive health care to women, a national survey of 1,800 practicing obstetricians-gynecologists found that 97% reported that they encountered patients seeking abortions, even though only 14% provided abortion services (
Stulberg et al., 2011
). Accurate information regarding the logistics of obtaining an abortion, such as gestational age limits and the necessity of parental or spousal consent and/or notification, is necessary for women to make informed decisions and navigate the process as smoothly as possible to obtain the care they desire. Given the findings of Stulberg and associates (2011), it seems reasonable to conclude that many reproductive health care providers will be asked questions pertaining to abortion laws and regulations by their patients who seek abortion services. Additionally, clinicians who perform abortions may be subject to criminal liability if they do not follow the state laws and regulations regarding abortion (Baker and Beresford, 2009
). It is unknown whether providers of reproductive health services have accurate knowledge of the abortion laws and regulations in the states where they practice.The primary aim of this study was to assess knowledge of state-level abortion laws and regulations among clinicians who provide reproductive health care. The secondary aim was to assess factors related to more accurate knowledge of these laws and regulations, including the provision of abortion services. This is the first study that we are aware of to examine knowledge of state-level abortion laws and regulations among clinicians in the United States.
Methods
Clinician members of several reproductive health professional organizations were recruited both in person and online. Clinicians were recruited in person from the 2010 American Congress of Obstetrics and Gynecology Annual Clinical Meeting to complete a short self-administered paper survey. Clinicians were recruited online through emails sent to the member lists of the Association of Reproductive Health Professionals, The Association of Physician Assistants in Obstetrics and Gynecology, the Association of Professors of Gynecology and Obstetrics, and the Society of Family Planning. The email directed participants to an online survey. These professional organizations were chosen in an attempt to recruit participants who were the most likely to provide reproductive health care and to recruit both abortion providers and nonproviders. To allow a comparison between abortion providers and nonproviders, and because so few clinicians provide abortion services, we deliberately chose organizations that enabled us to oversample abortion providers. Respondents were excluded if they did not report the state where they worked, if they practiced outside the United States, or if they reported not currently providing reproductive health care, which was defined as prenatal care, contraception counseling, screening for sexually transmitted infections, and abortion services. On behalf of the participants, a $10 donation was made to the charity of their choice upon completion of the survey. We conducted a sensitivity analysis limited to respondents who were recruited online to evaluate whether recruitment methods affected the results.
Respondents were asked if laws and regulations were present in the state where they worked using a modified yes/no response to assess how confident they were in their answers; the options were the following: “Yes, I am very sure,” “yes, I am somewhat sure,” “I don't know,” “no, I am somewhat sure,” and “no, I am very sure.” Responses were graded according to the Guttmacher Institute's State Policies in Brief: An Overview of Abortion Laws (
Guttmacher Institute, 2010
). A response of “I don't know” was considered incorrect. To assess how confident respondents were in their answers, the proportion of respondents with correct knowledge who reported that they were only somewhat sure of their answers are reported. We tracked changes in the laws and regulations over the study period and took these changes into account when scoring the responses. To assess factors that may be associated with better knowledge and may have implications for policy interventions, participants were asked whether they ever received reminders of state abortion laws and regulations at their practice. If they responded that they received reminders, they were asked who was responsible for issuing the reminders. Participants also were asked about demographic characteristics, practice characteristics, and personal beliefs related to abortion using a survey tool that was developed by Ibis Reproductive Health and modified for use in this study. A copy of the survey tool is available from the corresponding author upon request. With regard to the questions on provision of services, if a respondent partially answered a column with only “yes” responses, the unanswered rows were assumed to be responses of “no.” An overall knowledge score was constructed. Scores could range from 0 to 100, with higher scores indicating better knowledge.Guttmacher Institute (2010). State policies in brief: An overview of abortion laws. Accessed 2010 from: http://www.guttmacher.org/statecenter/spibs/spib_OAL.pdf
Data analysis was conducted using SAS 9.2 (SAS Institute, Cary, NC). Data are presented as proportions, medians with the interquartile range, or means with the standard deviation. Comparisons were made using chi-square, Fisher's exact, and Mann-Whitney U tests. All tests were two sided, and p < .05 was considered to be significant.
The Institutional Review Board at Beth Israel Deaconess Medical Center determined this study satisfied the criteria for the exempt category of research.
Results
Participants
A total of 341 surveys were completed between June 2010 and April 2011. Thirty-four respondents did not report the state where they work, 24 did not currently provide reproductive health care, and 1 reported practicing outside the United States. Given that our objective was to assess state-based knowledge among clinicians who would encounter women seeking abortion services, these 59 respondents were excluded from the analysis. Of the remaining 282, most (80.1%) were physicians, and over half (55.0%) reported currently providing abortion services (surgical and/or medical abortion). Clinicians also reported personally providing family planning services (99.3%), screening for sexually transmitted infections (95.4%), and prenatal care (67.7%). Respondents replied from 43 states; the states with the largest representation were New York (13.1%) and California (11.4%).
Of the 282 respondents, one third (34.0%) were recruited through the Association of Professors of Gynecology and Obstetrics, 27.3% were recruited through the Society of Family Planning, 17.0% were recruited through the American Congress of Obstetrics and Gynecology, 13.1% were recruited through the Association of Physician Assistants in Obstetrics and Gynecology, and 8.5% were recruited through the Association of Reproductive Health Professionals. We are unable to calculate a response rate for the 2010 meeting of the American Congress of Obstetrics and Gynecology. For the email-based surveys, several organizations sent the email themselves to protect the privacy of their members. Based on estimates from three of the four organizations regarding the number of emails sent, our response rate was 17.6%.
Most physicians (93.7%) reported their specialty as obstetrics and gynecology. Of the obstetrician-gynecologists, half (49.8%) were generalists and one third (33.9%) were family planning subspecialists. The majority of respondents (62.9%) reported that at least one of their practice types was academic, and most (84.0%) reported being White or Caucasian. Respondent characteristics are shown in Table 1.
Table 1Respondent Characteristics (n = 282)
| Characteristic | n (%) |
|---|---|
| Age (y) | |
| <30 | 15 (5.3) |
| 30–39 | 110 (39.0) |
| 40–49 | 82 (24.1) |
| 50–59 | 60 (21.3) |
| 60 or older | 29 (10.3) |
| Years in the state, median (IQR) | 8.0 (4.0–15.0) |
| Clinician type | |
| Physician | 226 (80.1) |
| Specialty | |
| Obstetrics-gynecology | 208 (93.7) |
| Family medicine | 11 (5.0) |
| Other | 3 (1.4) |
| Subspecialty | |
| None | 110 (49.8) |
| Family planning | 75 (33.9) |
| Maternal-fetal medicine | 17 (7.7) |
| Urogynecology | 6 (2.7) |
| Reproductive endocrinology | 3 (1.4) |
| Other | 10 (4.5) |
| Physician assistant | 36 (12.8) |
| Advanced practice nurse | 13 (4.6) |
| Other | 7 (2.5) |
| Practice type | |
| Private | 57 (20.2) |
| Public | 24 (8.5) |
| Title X clinic | 47 (16.7) |
| Hospital | 66 (23.4) |
| Academic | 174 (61.7) |
| Other | 8 (2.8) |
| Hispanic | 7 (2.5) |
| Race | |
| White or Caucasian | 237 (84.0) |
| Black or African American | 7 (2.5) |
| Asian | 22 (7.8) |
| Other/>1 race | 16 (5.7) |
Abbreviation: IQR, interquartile range.
∗ These options were only offered in the online survey (n = 217), although some respondents to the paper survey specified these subspecialties in the ‘other’ section.
Knowledge of State Abortion Laws and Regulations
Nearly all respondents (86.5%) considered themselves to be informed of the abortion laws and regulations present in their state. Most respondents knew that spousal consent and spousal notification are not required for married women to obtain an abortion (86.2% and 85.8% correct, respectively), although some respondents (14.8% and 15.3%, respectively) reported being only somewhat sure of their answer. Respondents also had highly correct knowledge regarding an individual's right to refuse to participate in abortion services (89.7%; 13.4% were only somewhat sure of their answer). Respondents' lowest knowledge was regarding whether so-called partial-birth abortion was banned in the state where they practiced (32.3%; 47.3% were only somewhat sure of their answer) and the requirement of state-mandated counseling before the procedure for women seeking an induced abortion (57.8%; 23.9% were only somewhat sure of their answer). Knowledge of whether parental notification (61.0%; 18.0% were only somewhat sure of their answer) and parental consent (69.5%; 17.9% were only somewhat sure of their answer) were required was relatively low. More respondents knew whether private insurance was allowed to fund abortions (77.0%) than knew whether Medicaid is allowed to fund abortions (56.0%) in their state. The overall knowledge score was 70.5 (standard deviation, 18.8). In the sensitivity analysis of respondents who were recruited online (n = 234), knowledge of state laws and regulations did not differ from that obtained in the overall analysis (all p > .36). Thus, the results are presented for all respondents together, regardless of whether they were recruited in-person or through email. Overall knowledge of state laws and regulations is shown in Table 2.
Table 2Knowledge of State Abortion Laws and Regulations Overall and Stratified by Reminder Status and Status of Abortion Provision
| Characteristic | Overall n (%) (n = 282) | Reminders (n = 131), n (%) | No Reminders (n = 151), n (%) | p | Provider (n = 155), n (%) | Nonprovider (n = 127), n (%) | p |
|---|---|---|---|---|---|---|---|
| Overall knowledge (mean ± SD) | 70.5 ± 18.8 | 74.4 ± 15.9 | 67.2 ± 20.5 | .001 | 75.0 ± 14.9 | 65.1 ± 21.6 | <.001 |
| Consider myself informed | 244 (86.5) | 123 (93.9) | 121 (80.1) | .001 | 147 (94.8) | 97 (76.4) | <.001 |
| Must be performed by a physician | |||||||
| Correct | 191 (67.7) | 98 (74.8) | 93 (61.6) | .02 | 103 (66.5) | 88 (69.3) | .61 |
| Only somewhat sure | 41 (21.5) | 19 (19.4) | 22 (23.7) | .47 | 15 (14.6) | 26 (29.6) | .01 |
| “Partial-birth” abortion is banned | |||||||
| Correct | 91 (32.3) | 34 (26.0) | 57 (37.8) | .03 | 46 (29.7) | 45 (35.4) | .30 |
| Only somewhat sure | 43 (47.3) | 15 (44.1) | 28 (49.1) | .64 | 20 (43.5) | 23 (51.1) | .47 |
| Institutions may refuse to participate | |||||||
| Correct | 202 (71.6) | 100 (76.3) | 102 (67.6) | .10 | 106 (68.4) | 96 (75.6) | .18 |
| Only somewhat sure | 49 (24.3) | 17 (17.0) | 32 (31.4) | .02 | 21 (19.8) | 28 (29.2) | .12 |
| Individuals may refuse to participate | |||||||
| Correct | 253 (89.7) | 122 (93.9) | 131 (87.3) | .07 | 142 (92.2) | 111 (88.1) | .25 |
| Only somewhat sure | 34 (13.4) | 11 (9.0) | 23 (17.6) | .047 | 15 (10.6) | 19 (17.1) | .13 |
| Parental notification | |||||||
| Correct | 172 (61.0) | 89 (67.9) | 83 (55.0) | .03 | 114 (73.6) | 58 (45.7) | <.001 |
| Only somewhat sure | 31 (18.0) | 7 (7.9) | 24 (28.9) | <.001 | 13 (11.4) | 18 (31.0) | .002 |
| Parental consent | |||||||
| Correct | 196 (69.5) | 96 (73.9) | 100 (66.2) | .17 | 126 (81.8) | 70 (55.1) | <.001 |
| Only somewhat sure | 35 (17.9) | 7 (7.3) | 28 (28.0) | <.001 | 9 (7.1) | 26 (37.1) | <.001 |
| Spousal notification | |||||||
| Correct | 242 (85.8) | 119 (90.8) | 123 (81.5) | .2 | 142 (91.6) | 100 (78.7) | .002 |
| Only somewhat sure | 37 (15.3) | 12 (10.1) | 25 (20.3) | .03 | 12 (8.5) | 25 (25.0) | <.001 |
| Spousal consent | |||||||
| Correct | 243 (86.2) | 120 (92.3) | 123 (82.0) | .01 | 143 (92.3) | 100 (80.0) | .003 |
| Only somewhat sure | 36 (14.8) | 11 (9.2) | 25 (20.3) | .01 | 12 (8.4) | 24 (24.0) | .001 |
| Waiting period | |||||||
| Correct | 226 (80.1) | 114 (88.4) | 112 (74.7) | .004 | 139 (90.9) | 87 (69.1) | <.001 |
| Only somewhat sure | 33 (14.6) | 6 (5.3) | 27 (24.1) | <.001 | 7 (5.0) | 26 (29.9) | <.001 |
| Length of waiting period | 69 (75.0) | 43 (84.3) | 26 (63.4) | .02 | 36 (83.7) | 33 (67.4) | .07 |
| Gestational age limit | |||||||
| Correct | 209 (74.1) | 97 (75.8) | 112 (75.2) | .91 | 116 (76.3) | 93 (74.4) | .71 |
| Only somewhat sure | 50 (23.9) | 15 (15.5) | 35 (31.3) | .01 | 23 (19.8) | 27 (29.0) | .12 |
| Mandatory counseling | |||||||
| Correct | 163 (57.8) | 83 (63.9) | 80 (54.1) | .10 | 102 (66.7) | 61 (48.8) | .003 |
| Only somewhat sure | 39 (23.9) | 17 (20.5) | 22 (27.5) | .29 | 16 (15.7) | 23 (37.7) | .001 |
| Medicaid funding | 158 (56.0) | 85 (64.9) | 73 (48.3) | .01 | 111 (71.6) | 47 (37.0) | <.001 |
| Private insurance funding | 217 (77.0) | 118 (90.1) | 99 (65.6) | <.001 | 141 (91.0) | 76 (59.8) | <.001 |
Abbreviation: SD, standard deviation.
Only 46.5% of respondents reported that they ever received reminders at their practice of the state's abortion laws and regulations. Among these respondents, 59.4% reported currently providing abortion services. Participants who reported receiving reminders were significantly more likely to consider themselves to be informed of the laws and regulations in their state compared with those who reported never receiving reminders (p = .001). Of those who reported receiving reminders, one third (32.8%) reported that they were the initiator of the reminders. In the remaining two thirds, the person initiating the reminders was an office manager (50.0%), a clinician (48.9%), and/or another staff member (17.0%). Those who reported receiving reminders had significantly better overall knowledge than those who did not receive reminders (p = .001). After stratifying by current provision of abortion services, this association remained among clinicians who did not provide abortion services (p = .04). Knowledge of state laws and regulations stratified by whether the respondent reported receiving reminders is presented in Table 2.
Fifty-five percent of respondents reported currently providing abortion services, reflecting our deliberate oversampling of abortion providers. Respondents who reported currently providing abortion services were significantly more likely to consider themselves to be informed of the abortion laws and regulations in their state compared with those who reported not currently providing abortion services (p < .001). Knowledge of state abortion laws and regulations stratified by whether the respondent reported currently providing abortion services is shown in Table 2. Abortion providers had significantly better knowledge of parental and spousal involvement, the presence of a mandatory waiting period and state-mandated counseling, and the coverage of abortion services by Medicaid and private insurers (all p < .004). Of respondents who had correct knowledge of these laws and regulations, abortion providers were more sure of their correct knowledge than nonproviders (all p < .003). There were no differences in the knowledge of the other laws and regulations examined between abortion providers and nonproviders, although knowledge of parental notification and the requirement of mandatory counseling were relatively low in both groups (73.6% vs. 45.7% and 66.7% vs. 48.8%, respectively). Abortion providers had significantly better overall knowledge than nonproviders (p < .001), and after stratifying by receipt of reminders, this association remained among clinicians who did not provide abortion services (p < .001).
Participants were asked to report the source(s) of their knowledge of state abortion laws and regulations. Half (49.3%) of respondents reported actively following the legislation, and 42.6% reported receiving information from a co-worker. Information was actively sought by 39.4% of respondents. One third (32.6%) of respondents reported receiving emailed materials, whereas fewer than one quarter (20.2%) reported receiving mailed materials.
Discussion
Although all participants reported currently providing reproductive health care, 13.5% did not consider themselves to be informed of the abortion laws and regulations present in their state. Although practicing clinicians had relatively high knowledge of some state abortion laws and regulations, such as their right to refuse to participate in abortion services and that spousal involvement is not required for married women seeking an induced abortion, many had inaccurate knowledge of other laws and regulations, such as the requirements for state-mandated counseling and parental notification. It is interesting to note that 14% of respondents did not have accurate information regarding spousal involvement, which is not required in any state, because it has been declared unconstitutional (
Planned Parenthood v. Danforth, 1975
, Planned Parenthood v. Casey, 1993
). Overall knowledge was significantly greater among clinicians who reported receiving reminders at their practice of the state's laws and regulations, which may indicate that these reminders could be used to increase knowledge among the clinical staff, especially among those who do not provide abortion services. Providers of reproductive health care are encouraged to consider ways to integrate reminders of state abortion laws and regulations into their practices. Knowledge was also significantly greater among physicians who reported currently providing abortion services compared with physicians who reported not currently providing abortion services.These findings suggest that although women seeking induced abortion likely receive accurate information from reproductive health care providers regarding many state abortion laws and regulations, there is the potential that some women may receive inaccurate information. However, this does not imply that clinicians who provide abortion services are not following the laws. In many cases, the front-line staff or the nursing staff may be more involved than the clinicians in completing the work required of many laws and regulations, such as parental involvement and the provision of state-mandated counseling. We previously examined the accuracy of information provided by front-line staff at facilities that provide abortion services, and found the information provided to be highly accurate, although we were unable to assess the accuracy of knowledge provided by front-line staff at reproductive health care facilities that do not provide abortion services (
Dodge et al., 2012
)This study is subject to several limitations. The respondents represent a sample of convenience in which most clinicians were obstetricians-gynecologists and in which abortion providers were deliberately oversampled. Many clinicians who provide reproductive health care are not physicians and/or do not specialize in obstetrics-gynecology; in addition, those who choose to complete a survey regarding abortion are probably not representative of all clinicians who provide reproductive health care. Fifty-five percent of respondents reported currently providing abortion services, although a national survey of 1,800 practicing obstetricians-gynecologists found that only 14% provided abortion services (
Stulberg et al., 2011
). Although this sample is not representative of all clinicians who provide reproductive health care, knowledge among this population is still of interest. Because we found abortion providers to be more knowledgeable regarding state laws and regulations than clinicians who do not provide abortion services, this convenience sample likely overestimates the knowledge of state abortion laws and regulations among general practitioners, and these results may represent the upper bound of such knowledge. Additionally, we were unable to calculate the exact response rate, and the estimated response rate was low, which also creates concerns surrounding generalizability. Those who chose to respond may have had different knowledge than nonrespondents. Respondents may have chosen to respond because of their interest in the topic, and thus they may have had better knowledge than nonrespondents. This also would make our findings an upper bound of knowledge.Although this study was intended to assess knowledge of the actual gestational age limit, this was not possible owing to the wording of the survey, which asked the respondents to provide an answer to this question in weeks of gestation. Many states prohibit abortion after viability, which does not have a clear definition, and we did not define this in terms of weeks of gestation. Additionally, we believe that, from a patient's perspective, it is more relevant to know the practical limit in the state, which is the latest gestational age at which abortion providers will provide an abortion in that state—regardless of whether it is legal to perform abortions beyond that gestational age in that state. However, this was not assessed in this study.
It also is important to note that women do not seek abortion care exclusively in the state where they reside. In 2009, approximately 8% of abortions in the United States were obtained by women outside their state of residence (
Pazol et al., 2012
) Women seek out-of-state abortions for a variety of reasons; an out-of-state provider may be the closest geographically, or they may provide services at a lower cost or a greater gestational age than in-state abortion providers. Therefore, reproductive health care providers may benefit their patients by knowing the laws in adjacent states, because this could theoretically result in access to more timely care. This is particularly relevant for reproductive health care providers near states that serve many out-of-state women, such as the District of Columbia, where 52% of abortions are provided to women who live outside the District of Columbia (Pazol et al., 2012
).A final and important limitation is that we were unable to measure the accuracy of the actual information received by women seeking abortion services and whether more accurate knowledge of state abortion laws and regulations among clinicians resulted in greater access to abortion services for women. Provider-level knowledge of laws and regulations as measured in this study may not be a reliable proxy for the information women receive from these providers. In addition, women may receive information regarding state abortion laws and regulations from sources other than reproductive health care providers. Inaccurate knowledge among providers of reproductive health care may not necessarily be transmitted to women or prevent them from obtaining accurate information from another source, although inaccurate information could potentially result in confusion and delays in care. Future work is needed to measure the information that women seeking abortion services receive from reproductive health care providers and other sources and whether that information affected their access to care.
Regardless of whether they provide abortion services, it seems reasonable to expect that clinicians who provide reproductive health care should be able to provide women with accurate information regarding state abortion laws and regulations, especially those that impact their ability to access abortion care, such as parental involvement and the presence of mandatory waiting periods. This is particularly important for clinicians who do not provide abortion services, because patients seeking abortion services require a referral to an abortion provider, which is an additional source of delay in care. With the rapidly changing landscape of abortion legislation, it is critical for clinicians who provide reproductive health care to remain up to date on these laws and regulations. Thus, there is a need for a regular mechanism to ensure that clinicians are aware of changing legislation to provide the most accurate information to patients seeking abortion services. Women seeking abortion services need information about the abortion laws and regulations in their state to navigate the system. Providers of reproductive health care are a logical resource to assist women, but to do so they must have accurate knowledge of the laws and regulations.
Acknowledgments
This project was conducted with grant support from the Harvard University William F. Milton Endowment.
The authors are grateful to Dr. Milton Kotelchuck for his valuable assistance in the development of this project. We are also grateful to Ibis Reproductive Health for allowing us to use and modify their data collection instrument.
References
- Informed consent, patient education and counseling.in: Paul M. Lichtenberg E.S. Borgatta L. Grimes D.A. Stubblefield P.G. Creinin M.D. Management of unintended and abnormal pregnancy. Oxford: Blackwell Publishing, 2009: 48-62
- Breast cancer and abortion: collaborative reanalysis of data from 53 epidemiological studies, including 83 000 women with breast cancer from 16 countries.Lancet. 2004; 363: 1007-1016
- Abortion and long-term mental health outcomes: A systematic review of the evidence.Contraception. 2008; 78: 436-450
- Knowledge of state-level abortion laws and policies among front-line staff at facilities providing abortion services.Womens Health Issues. 2012; 22: e415-e420
Guttmacher Institute (2010). State policies in brief: An overview of abortion laws. Accessed 2010 from: http://www.guttmacher.org/statecenter/spibs/spib_OAL.pdf
Guttmacher Institute (2012). States enact record number of abortion restrictions in 2011. Available: http://www.guttmacher.org/media/inthenews/2012/01/05/endofyear.html
Guttmacher Institute (2013). State policies in brief: An overview of abortion laws. Accessed 2013 from: http://www.guttmacher.org/statecenter/spibs/spib_OAL.pdf
- Abortion incidence and access to services in the United States, 2008.Perspectives on Sexual and Reproductive Health. 2011; 43: 41-50
- Fetal pain: A systematic multidisciplinary review of the evidence.JAMA. 2005; 294: 947-954
- Abortion surveillance–United States, 2009.MMWR Surveillance Summaries. 2012; 61: 1-44
- Planned Parenthood of Central Missouri v. Danforth. 31 Jan 1975.Federal Supplement. 1975; 392: 1362-1379
- Planned Parenthood of Southeastern Pennsylvania v. Casey.Federal Supplement. 1993; 822: 227-239
- Abortion provision among practicing obstetrician-gynecologists.Obstetrics & Gynecology. 2011; 118: 609-614
Biography
Laura E. Dodge, MPH, is a clinical research assistant in the Department of Obstetrics and Gynecology at Beth Israel Deaconess Medical Center. She is currently pursuing a doctorate in epidemiology at the Harvard School of Public Health.
Sadia Haider, MD, MPH, is an obstetrician-gynecologist who specializes in family planning. Her domestic research interests include access to abortion and contraception, and her global research focuses on reproductive health and family planning, especially within conflict and post-conflict settings.
Michele R. Hacker, ScD, MSPH, directs the Program in Epidemiologic Research in the Department of Obstetrics and Gynecology at Beth Israel Deaconess Medical Center. She is also an Assistant Professor at the Harvard School of Public Health and at Harvard Medical School.
Article info
Publication history
Published online: August 01, 2013
Accepted:
June 20,
2013
Received in revised form:
June 20,
2013
Received:
November 5,
2012
Footnotes
This project was conducted with grant support from the Harvard University William F. Milton Endowment.
Identification
Copyright
© 2013 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.
