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Abortion restrictions in the state of Georgia: Anticipated impact on people seeking abortion

      Abstract

      Objective

      To explore the impact of restrictive abortion policies in the state of Georgia on the lives of people seeking abortion and how they would manage unwanted pregnancies.

      Study design

      We conducted a cross sectional study of English and Spanish-speaking people seeking abortion from three high-volume outpatient abortion clinics in Atlanta, Georgia from April 2019 through August 2019. Participants completed a multiple-choice questionnaire. We used bivariable and multivariable analysis to explore relationships between demographic characteristics and how people would manage their unwanted pregnancies if abortion were illegal in the state. Two researchers (EC and SC) conducted qualitative analysis on free response answers and coded them by key emotion.

      Results

      Of the 382 participants, 312 (81.9%) considered at least one way to end their pregnancy if abortion were illegal in Georgia: 252 (66.1%) by traveling to another state, 85 (22.3%) by self-management with medications and/or herbs, and 32 (8.4%) considered self-harm behaviors. When asked how they would feel about not being able to have a desired abortion, 94% reported negative emotions, ranging from “scared” to “enslaved.”

      Conclusions

      Limiting access to legal abortion in Georgia would negatively impact the lives of people seeking abortion and has the potential to drive individuals to seek more costly and risky alternatives to end their pregnancy.

      Implications

      Restricting abortion in Georgia may cause medically unnecessary delays in care, increased travel time, cost and negative emotional responses to people seeking abortion. Mitigating strategies include legislative challenges to restrictive laws as well as harm reduction education.

      Keywords

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      References

        • Institute G
        State facts about abortion Georgia.
        Guttmacher Institute, New York2018
        • Jones R.
        • Witwer E.
        • Jerman J.
        Abortion incidence and service availability the United States, 2017.
        Guttmacher Institute, 2019: 24
        • Jatlaoui T.C.
        • Eckhaus L.
        • Mandel M.G.
        • et al.
        Abortion Surveillance - United States, 2016.
        MMWR Surveill Summ. 2019; 68: 1-41
      1. Assembly GG. 2019-2020 Regular Session - HB 481 Living Infants Fairness and Equality (LIFE) Act; enact. 2019.

        • Prabhu M.T.
        Federal judge throws out Georgia’s anti-abortion law.
        Atlanta Journal-Constitution, Atlanta2020: 1
        • McDonald J.H.
        Handbook of biological statistics.
        3rd ed. Sparky House Publishing, Baltimore, Maryland2014
        • Elbogen E.B.
        • Lanier M.
        • Montgomery A.E.
        • Strickland S.
        • Wagner H.R.
        • Tsai J.
        Financial strain and suicide attempts in a nationally representative sample of US Adults.
        Am J Epidemiol. 2020;
      2. Curtin S, Hedegaard H. Suicide rates for females and males by race and ethnicity: United States, 1999 and 2017. In: Statistics NCfH, editor.: National Center for Health Statistics; 2019.

        • Fuentes L.
        • Jerman J.
        Distance traveled to obtain clinical abortion care in the united states and reasons for clinic choice.
        J Womens Health. 2019; 28: 1623-1631
        • Jones R.K.
        • Jerman J.
        How far did US women travel for abortion services in 2008?.
        J Womens Health. 2013; 22: 706-713
        • Dehlendorf C.
        • Weitz T.
        Access to abortion services: a neglected health disparity.
        J Health Care Poor Underserved. 2011; 22: 415-421
        • Cook P.J.
        • Parnell A.M.
        • Moore M.J.
        • Pagnini D.
        The effects of short-term variation in abortion funding on pregnancy outcomes.
        J Health Econ. 1999; 18: 241-257
        • Gerdts C.
        • Fuentes L.
        • Grossman D.
        • et al.
        Impact of clinic closures on women obtaining abortion services after implementation of a restrictive law in Texas.
        Am J Publ Health. 2016; 106: 857-864
        • White K.
        • Baum S.E.
        • Hopkins K.
        • Potter J.E.
        • Grossman D.
        Change in second-trimester abortion after implementation of a restrictive state law.
        Obstet Gynecol. 2019; 133: 771-779
        • Joyce T.
        • Kaestner R.
        The impact of Mississippi's mandatory delay law on the timing of abortion.
        Fam Plann Perspect. 2000; 32: 4-13
        • Bartlett L.A.
        • Berg C.J.
        • Shulman H.B.
        • et al.
        Risk factors for legal induced abortion-related mortality in the United States.
        Obstet Gynecol. 2004; 103: 729-737
        • Moseson H.
        • Herold S.
        • Filippa S.
        • Barr-Walker J.
        • Baum S.E.
        • Gerdts C.
        Self-managed abortion: A systematic scoping review.
        Best Pract Res Clin Obstet Gynaecol. 2020; 63: 87-110
        • Aiken A.R.A.
        • Broussard K.
        • Johnson D.M.
        • Padron E.
        Motivations and experiences of people seeking medication abortion online in the United States.
        Perspect Sex Reprod Health. 2018; 50: 157-163
        • Grossman D.
        • Holt K.
        • Pena M.
        • et al.
        Self-induction of abortion among women in the United States.
        Reprod Health Matters. 2010; 18: 136-146
        • Jones R.K.
        How commonly do US abortion patients report attempts to self-induce?.
        Am J Obstet Gynecol. 2011; 204: e1-e4
        • Begun S.
        • Combs K.M.
        • Schwan K.
        • Torrie M.
        • Bender K.
        “I Know They Would Kill Me”: abortion attitudes and experiences among youth experiencing homelessness.
        Youth Soc. 2018; (0044118X18820661)
        • Ganatra B.
        • Gerdts C.
        • Rossier C.
        • et al.
        Global, regional, and subregional classification of abortions by safety, 2010–14: estimates from a Bayesian hierarchical model.
        Lancet (London, England). 2017; 390: 2372-2381
        • Biggs M.A.
        • Gould H.
        • Barar R.E.
        • Foster D.G.
        Five-year suicidal ideation trajectories among women receiving or being denied an abortion.
        Am J Psychiatry. 2018; (appiajp201818010091)
        • Hung P.
        • Busch S.H.
        • Shih Y.W.
        • McGregor A.J.
        • Wang S.
        Changes in community mental health services availability and suicide mortality in the US: a retrospective study.
        BMC Psychiatry. 2020; 20: 188
        • Liu Y.
        • Kaaya S.
        • Chai J.
        • et al.
        Maternal depressive symptoms and early childhood cognitive development: a meta-analysis.
        Psychol Med. 2017; 47: 680-689
        • Ralph L.J.
        • Mauldon J.
        • Biggs M.A.
        • Foster D.G.
        A prospective cohort study of the effect of receiving versus being denied an abortion on educational attainment.
        Womens Health Issues. 2019;
        • Foster D.G.
        • Biggs M.A.
        • Ralph L.
        • Gerdts C.
        • Roberts S.
        • Glymour M.M.
        Socioeconomic outcomes of women who receive and women who are denied wanted abortions in the United States.
        Am J Publ Health. 2018; 108: 407-413
        • Foster D.G.
        • Biggs M.A.
        • Raifman S.
        • Gipson J.
        • Kimport K.
        • Rocca C.H.
        Comparison of health, development, maternal bonding, and poverty among children born after denial of abortion vs after pregnancies subsequent to an abortion.
        JAMA Pediatr. 2018;
        • Miller S.
        • Wherry L.R.
        • Foster D.G.
        The economic consequences of being denied an abortion.
        National Bureau of Economic Research Working Paper Series, 2020 (No. 26662)
        • Grossman D.
        • White K.
        • Hopkins K.
        • Potter J.E.
        Change in distance to nearest facility and abortion in Texas, 2012 to 2014.
        Jama. 2017; 317: 437-439
      3. America’s Health Rankings analysis of CDC WONDER Online Database, Mortality files. United Health Foundation.

        • Grossman D.
        • Baum S.E.
        • Andjelic D.
        • et al.
        A harm-reduction model of abortion counseling about misoprostol use in Peru with telephone and in-person follow-up: A cohort study.
        PloS one. 2018; 13e0189195
        • Kahabuka C.
        • Pembe A.
        • Meglioli A.
        Provision of harm-reduction services to limit unsafe abortion in Tanzania.
        Int J Gynaecol Obstet. 2017; 136: 210-214
        • Stifani B.M.
        • Couto M.
        • Lopez G.A.
        From harm reduction to legalization: The Uruguayan model for safe abortion.
        Int J Gynaecol Obstet. 2018; 143: 45-51
        • Tasset J.
        • Harris L.H.
        Harm reduction for abortion in the United States.
        Obstet Gynecol. 2018; 131: 621-624