Abortion and the Mission of MCH: Perspectives of MCH and Family Planning Professionals in Health Departments

Introduction Prior research shows that maternal and child health (MCH) and family planning (FP) divisions in health departments (HDs) engage in some abortion-related activities, largely when legally mandated; some agencies also initiate abortion-related activities. Yet little is known about health department MCH/FP professionals’ views on how abortion-related work aligns with their professional mission. Methods Between November 2017 and June 2018, we conducted in-depth interviews with 29 MCH/FP professionals working in 22 state and local HDs across the U.S. We conducted inductive thematic analysis to identify themes regarding participants’ professional mission and values in relation to abortion-related work. Results Participants described a strong sense of professional mission. Two contrasting perspectives on abortion and the MCH/FP mission emerged: some participants saw abortion as clearly outside the scope of their mission, even a threat to it, while others saw abortion as solidly within their mission. In states with supportive or restrictive abortion policy environments, professionals’ views on abortion and professional mission generally aligned with their overall state policy environment; in states with middle-ground abortion policy environments, a range of perspectives on abortion and professional mission were expressed. Participants who saw abortion as within their mission anchored their work in core public health values such as evidence-based practice, social justice, and ensuring access to health care. Discussion There appears to be a lack of consensus about whether and how abortion fits into the mission of MCH/FP. More work is needed to articulate whether and how abortion aligns with the MCH/FP mission.

State Abortion Policies and Maternal Death in the United States, 2015‒2018

Objectives. To examine associations between state-level variation in abortion-restricting policies in 2015 and total maternal mortality (TMM), maternal mortality (MM), and late maternal mortality (LMM) from 2015 to 2018 in the United States. Methods. We derived an abortion policy composite index for each state based on 8 state-level abortion-restricting policies. We fit ecological state-level generalized linear Poisson regression models with robust standard errors to estimate 4-year TMM, MM, and LMM rate ratios and 95% confidence intervals (CIs) associated with a 1-unit increase in the abortion index, adjusting for state-level covariates. Results. States with the higher score of abortion policy composite index had a 7% increase in TMM (adjusted rate ratio [ARR] = 1.07; 95% CI = 1.02, 1.12) compared with states with lower abortion policy composite index, after we adjusted for state-level covariates. Among individual abortion policies, states with a licensed physician requirement had a 51% higher TMM (ARR = 1.51; 95% CI = 1.15, 1.99) and a 35% higher MM (ARR = 1.35; 95% CI = 1.09, 1.67), and states with restrictions on Medicaid coverage of abortion care had a 29% higher TMM (ARR = 1.29; 95% CI = 1.03, 1.61). Conclusions. Restricting access to abortion care at the state level may increase the risk for TMM. (Am J Public Health. Published online ahead of print August 19, 2021: e1–e9. https://doi.org/10.2105/AJPH.2021.306396 )

Pro-Life and Feminist Mobilization in the Struggle over Abortion in Mexico: Church Networks, Elite Alliances, and Partisan Context

ABSTRACT This article comparatively analyzes the strategies and political impact of “pro-life” and feminist movements in the struggle over abortion policy in Mexico. Drawing on extensive fieldwork, it argues that anti-abortion movements are more likely to influence policymaking in contexts where they can tap into hegemonic religious institutions’ networks and alliances and indirectly provide incumbents with legitimizing moral and financial support in exchange for restrictive reforms. Partisan contexts shape incumbents’ need for such support. Feminist activists, by contrast, have neither elite connections nor access to similar mobilization resources. To make this argument, the analysis examines pro-life and feminist movements in two Mexican states: Yucatán, where Congress passed a restrictive reform; and Hidalgo, where an identical initiative failed.

Comparative Abortion Law and Politics

Public debate rages around the world as to if and when a woman has a right to access abortion services. Though abortion policy has become more permissive over time in various places, there are still many countries with severe restrictions. The variety in state abortion policies at the state and regional levels reflects the different religious, cultural, and political attitudes toward this issue. Literature on this topic engages with larger theoretical debates within the study of public policy. That includes definitions of morality policy and determinants of feminist policy. Researchers continue to search for the ideal way to compare permissiveness of abortion policy in light of the extensive variation, conditions, and caveats that exist within abortion legislation. A number of variables, including female political representation, dominant religious groups in the country, and women’s movements have emerged as central correlates with permissiveness of abortion policy. The difference between de jure abortion law and de facto access also constitutes an important part of abortion policy research.

Perceived Access to Abortion Among Women in the United States in 2018: Variation by State Abortion Policy Context

Objectives. To describe perceptions of access to abortion among women of reproductive age and their associations with state abortion policy contexts. Methods. We used data from the 2018 Survey of Family Planning and Women’s Lives, a probability-based sample of 2115 adult women aged 18 to 44 years in US households. Results. We found that 27.6% of women (95% confidence interval [CI] = 23.3%, 32.7%) believed that access to medical abortion was difficult and 30.1% of women (95% CI = 25.6%, 35.1%) believed that access to surgical abortion was difficult. Adjusted for covariates, women were significantly more likely to perceive access to both surgical and medical abortions as difficult when they lived in states with 4 or more restrictive abortion policies compared with states with fewer restrictions (surgical adjusted odds ratio [AORsurgical] = 1.60, 95% CI = 1.15, 2.21; AORmedical = 1.65, 95% CI = 1.04, 1.95). Specific restrictive abortion policies (e.g., public funding restrictions, mandatory counseling or waiting periods, and targeted regulation of abortion providers) were also associated with greater perceived difficulty accessing both surgical and medical abortions. Conclusions. State policies restricting abortion access are associated with perceptions of reduced access to both medical and surgical abortions among women of reproductive age.

Pseudoscience and Abortion Policy

This chapter demonstrates how arguments against abortion are often based on pseudoscience. Twenty-nine states, home to 88 million women, have implemented at least two state-wide abortion restrictions not backed by scientific evidence. For example, Texas’s “A Woman’s Right to Know” booklet, offered to patients before having an abortion, uses deceptive language to lead readers to believe that abortion increases the risk of breast cancer. The American College of Obstetricians and Gynecologists released a statement in 2009 concluding that there is “no association between induced abortion and breast cancer.” Meanwhile, Kentucky’s Senate Bill 5, passed in 2017, made it illegal to have an abortion after the twentieth week of pregnancy. The sponsor of the bill cited fetal pain as justification for the law, calling abortion after 20 weeks an “awful painful experience” for the fetus. However, a review of fetal pain evidence found that fetuses are unlikely to feel pain before the third trimester (around 29 weeks). Overall, Kansas, Texas, and South Dakota have the highest number of these types of pseudoscientific information policies in place.