OBJECTIVE:While most people in the United States obtain abortion care in outpatient settings, such facilities may limit care for some individuals because of a variety of conditions. The situations when abortion care cannot be obtained in the outpatient setting have not been evaluated, leaving a deficit in understanding the need for hospital-based abortion care. METHODS:We obtained outpatient abortion facility care protocols from the Society of Family Planning #We Count project, which, in January 2024, invited participating organizations with outpatient physical facilities to share their protocols for determining when patients were unable to be cared for in their facility(ies). Using summative content analysis, we identified health conditions for which a patient could be deemed ineligible, organizing individual conditions thematically and, as appropriate, by organ system. RESULTS:We analyzed 20 unique protocols. Protocols delineated ineligibility for temporary conditions (e.g., fever), conditions specific to current pregnancy (e.g., placenta previa), conditions related to the patient's reproductive history or conditions (e.g., history of uterine surgery), and chronic conditions (e.g., hypertension). Protocols varied in quantity of limiting conditions (range: two to 26 conditions) and most frequently included limits to outpatient care for heart disease (15 [75%]), bleeding conditions (15 [75%]), seizure disorders (15 [75%]), hypertension (13 [65%]), anemia (12 [60%]), and asthma (11 [55%]). The definitions for a given condition as a limit for care frequently varied between protocols. CONCLUSIONS:US outpatient abortion clinics commonly define limitations to outpatient care, but the specific limiting conditions and their criteria vary substantially across protocols.

Background: Almost immediately after the landmark 2022 Dobbs decision overturning the legal right to abortion established under Roe v. Wade, important questions emerged about the possible effects of the state-level bans and severe restrictions on abortion that Dobbs allowed, including denial or dangerous delay in providing care that had been available pre-Dobbs. Theoretically, these new state-level abortion restrictions permit exceptions for what is variably described as a "threat to the life" of the pregnant woman. In practice, however, the actual determination of when a pregnant person has reached the threshold of this legal language is often vague and subjective. How clinicians have navigated patient care, including obstetric emergencies, in this context, and what it means for their experiences of work is an important area of study. Methods: Drawing on in-depth interviews with clinicians (n = 29), we document how the Dobbs-driven changes in pregnancy care have impacted clinicians both in states in which abortion is banned or severely restricted and those where it remains largely unrestricted. Results: It is not just clinicians in states that have severely restricted abortion who have been impacted; clinicians in states where abortion remains broadly legal are central to protecting patients' lives and health when they experience the dangers of pregnancy. Conclusions: We close by speculating on the consequences of this rising awareness of the importance of access to abortion care for obstetric patients and possibilities for shifts in public support for clinicians who provide abortion care.

OBJECTIVES:This study aimed to document categories of patient scenarios wherein the timing of pregnancy-related care in the United States has been negatively affected despite the risk of health harms by post-Dobbs abortion laws. STUDY DESIGN:Between November 2022 and October 2024, we conducted semistructured phone interviews with 36 health care professionals in the United States who were involved in care for a pregnant patient who did not receive the standard of care due to post-Dobbs laws. We analyzed the interviews using a flexible coding approach and grounded theory. RESULTS:We identified three categories of patient scenarios wherein care that clinicians judged necessary to prevent or reduce future health harm was delayed or denied: patients who had an existing health condition whose severity was exacerbated by pregnancy; patients for whom the pregnancy itself was the health condition clinicians anticipated would lead to medical endangerment or death; and serious fetal health conditions that would result in inevitable fetal or infant death. In all three, the absence of a current life-threatening emergency - even when one was near certain in the future - prevented clinicians from offering abortion care and increased the risk of health harms. CONCLUSIONS:Restrictive post-Dobbs laws' inflexible focus on the patient's and/or fetus's current health status prevented clinicians from using their knowledge and experience to prevent future health harms, turning clinical care for pregnancy into an exclusively reactive practice. These laws reorient care for pregnant patients to only allow interventions based on present health and, in effect, prohibit care that will prevent or reduce future harm. IMPLICATIONS:Restrictive post-Dobbs laws change the practice of obstetric medicine and constrain clinicians' ability to offer pregnant patients care that will prevent or reduce future harm, illustrating a concerning policy outcome and highlighting the health dangers of these laws.

Importance:Since the Supreme Court's 2022 decision in Dobbs v Jackson Women's Health Organization, state legislatures have enacted laws severely restricting abortion. Facility case studies have reported post-Dobbs increases in patient volume and gestational length at abortion. Objective:To understand changes from before to after the Dobbs decision in the overall volume of callers and gestational length of their pregnancies at a large, regional abortion fund. Design, Setting, and Participants:This cross-sectional study used data from monthly caller records (June 2016-June 2024) from the District of Columbia Abortion Fund (DCAF) using interrupted time series analyses with segmented regression. DCAF serves the Washington, DC, area, which is unique in its absence of gestational restrictions, service availability, and proximity to states with post-Dobbs restrictions. Data were analyzed from November 2024 through August 2025. Exposure:Time in months, with change points and discontinuities after the Dobbs decision. To contextualize trends, change points and discontinuities were examined at the onset of the COVID-19 pandemic, the enactment of a 6-week abortion ban in Texas, and the enactment of a 12-week ban in North Carolina. Main Outcomes and Measures:Overall call volume and gestational length of callers, measured dichotomously (first trimester vs ≥13 weeks) and continuously (weeks' gestation). Results:Among 43 351 DCAF caller records, 31% had pregnancies at 13 weeks' gestation or greater. After the Dobbs decision, there was a sudden and substantial reversal of a prior 6-year trend of increasing call volume, as indicated by both an immediate drop (from 721 to 663 callers per month; coefficient, -10.7% [95% CI, -16.8% to -4.7%]), and a continued decrease over the subsequent year (coefficient, -12.7% [95% CI, -13.6% to -11.6%] per month). Concurrently, there was a sharp increase in the proportion of callers whose pregnancies were at 13 weeks' gestation or later, from approximately 22% just before Dobbs to 32% the month after the Dobbs decision (odds ratio [OR], 1.61 [95% CI, 1.39 to 1.87]); this increase continued (OR per month, 1.07 [95% CI, 1.06 to 1.09]), reaching a peak of 53% per year post-Dobbs. Both trends reversed after the enactment of North Carolina's 12-week ban. Conclusions and Relevance:In this cross-sectional study of caller records at a large abortion fund, there were immediate and lasting changes in the volume and gestational length of callers following the Dobbs decision, suggesting differential redistribution of access or care-seeking by trimester and/or delays in presentation for care.

Research demonstrates that programming and curricula that is affirmative and inclusive of sexual and gender minority (SGM) people is potentially lifesaving for students in middle and high school. There has been little examination, however, of SGM-affirmative programming at the elementary school level. Elementary school level programming has the potential to benefit SGM youth and families, as well as lead to more affirmative attitudes in later school settings. This study reports on the factors that create and sustain an elementary after school program that has implemented SGM-affirmative programming within a social justice and arts framework for over 20 years. We conducted thematic analysis of interviews with teachers, administrators, and parents in the program and the associated elementary school to identify factors that contribute to the program's success in affirming and including SGM people. Findings highlight affirmative policies and systems (inclusive mission statements, policies encouraging expression, and hiring diverse staff) and consistent enactment of inclusive and affirmative behaviors (affirming diversity, implementing inclusive curriculum, using inclusive language, and disrupting normativity and implementing restorative practices) as key components of an SGM-affirmative program with elementary-aged students. Results highlight that creating an SGM-affirmative elementary level program is possible and provide an exemplar of this programming in action. Implications and potential focus areas for policy and practice implementation are discussed.

OBJECTIVES:This is a protocol for a Cochrane Review (qualitative). The objectives are as follows: This QES aims to address the following question: What are the lived experiences and perceptions of abortion seekers (i.e. pregnant women, transgender men, and non-binary people of any gender) traveling to obtain care? The review objectives are to: synthesize the qualitative evidence to address the review question; identify factors that influence abortion travel experiences and perspectives, which may include the specific abortion regulatory and care delivery context (e.g. legal restrictions, unavailability) and abortion seekers' personal circumstances (e.g. age, race/ethnicity, gender, partnership status, gestational duration, social/family support, income/wealth).

For over a century, abortion has been politically and socially contested, affecting people's lives through personal experience and/or public discourse. In the United States (US), abortion is sometimes exceptional—treated differently from other procedures, professions, and political issues—and sometimes an exemplar—an accessible example of a commonly occurring social, political, or personal phenomenon. It is, in other words, an excellent sociological case study. Yet the sociological literature on abortion is relatively thin. In this essay, we review research on abortion and opportunities for future sociological work in eight areas: gender; race; the body and embodiment; political economy; organizations, occupations, and work; medical sociology; law and society; and social movements. Sociologists have much to contribute to characterizing and understanding abortion, particularly following the 2022 US Supreme Court decision overturning the constitutional right to abortion. The discipline also has much to learn from studying abortion as a case. With its multifaceted social and political status and intersections with key areas of sociological interest, abortion offers a generative case for advancing sociological concepts, subfields, and constructs. While not exhaustive, our review aims to spark interest and inquiry, showcasing how a topic that spurs strong opinions can also catalyze sociological insights.

CONTEXT:In the United States, fetal development markers, including "viability" and the point when a fetus can "feel pain," have permeated the social imaginary of abortion, affecting public support for abortion and the legality and availability of care, but the extent to which these markers describe and orient the experience of abortion at later gestations is unclear. METHODS:Using interviews with 30 cisgender women in the United States who obtained an abortion after 24 weeks of pregnancy, the authors investigated whether and how notions of fetal viability and/or pain operated in the women's lived experiences of pregnancy and abortion. FINDINGS:According to respondents' accounts, fetal development-based laws restricting abortion based on purported points of fetal development operated as gestational limits, privileged the viability and pain status of the fetus over that of the prospective neonate, and failed to account for the viability and pain of the pregnant person. CONCLUSIONS:The discursive practice of centering fetal development in regulating abortion access makes denial of abortion care because of the fetus's status conceptually available-even at the point of fertilization-and naturalizes the erasure of the subjectivity of women and others who can become pregnant.

Research documents how abortion can be emotionally difficult and stigmatising, but generally has not considered whether and how involvement in abortion may be a source of positive emotions, including pleasure, belonging and even joy. The absence of explorations that start from the possibility of abortion pleasure and joy represents an epistemic foreclosure. Moreover, it highlights how social science literature has tended to emphasise the negative aspects of abortion care in ways that produce or amplify normative negative associations. In this paper, we investigate the positive emotions, pleasure and joy of abortion involvement by drawing on interviews conducted in 2019 with 28 abortion accompaniers in Argentina, Chile, and Ecuador about their experiences accompanying abortions after 17 weeks' gestation. Abortion accompaniment is a response to unsafe and/or inaccessible abortion whereby volunteer activists guide abortion seekers through a medication abortion. Interviewees described how the practice of accompaniment generated positive emotions by building a feminist community, shared intimacy among women, and witnessing aborting people claim their strength. Importantly, these positive emotional experiences of involvement with abortion were not distinct from the broader marginalisation of abortion but were, instead, rooted in its marginalisation.

Primary dysmenorrhea (PD) is a leading cause of gynecological morbidity, but it is often accepted as a normal part of menstruation, and few women report PD or seek medical care. Using modified grounded theory, we examined the accounts of patients with PD via online narratives. Uncertainty and isolation emerged as extra-medical dimensions that worsened the experience of PD. Clinical encounters in which patients felt that their pain was dismissed or clinicians did not know much about PD may inadvertently exacerbate the experience of challenging menses. We found that people experiencing PD have an unmet need for social and emotional support and that clinicians have an opportunity to address the social dimensions of PD.

Abortion in the global South is highly restricted. The social, economic, and health problems engendered by this restriction are often relegated to the discipline of public health and considered a technical problem to be solved through policy change, international pressure, and Northern aid. In recent years, however, local activists around the world have responded to legal restrictions by counseling and supporting abortion seekers online, by phone, and in person in self-managing their own abortions. In Latin America, this direct-action tactic, known as abortion accompaniment, is led largely by self-identified feminist collectives. In this article, we examine the feminist orientation of abortion accompaniment, considering how the model engages with a feminist ethic of care, reflexivity, and intersectionality—and to what effect. Drawing on in-depth interviews with abortion accompaniers in Argentina, Chile, and Ecuador, we show that abortion accompaniment cannot be understood as merely a response to legal restrictions. Rather, accompaniment is activism rooted in a feminist approach. The model of abortion care implemented by accompaniment groups includes direct action, justice, and listening. We argue that abortion accompaniment is a unique and innovative feminist praxis that is shaped by both previous feminist intellectual commitments and feminist emotional connections forged through the abortion process, resulting in a reflexive feminist theoretical model that centers care and exists fully outside the state and the formal health care system.

Objectives We aimed to document US healthcare providers’ reports of medical care that differed from the usual standard due to abortion restrictions enacted since the Dobbs v Jackson Women’s Health Organization decision. Methods We solicited submissions through online and email networks of healthcare providers. Participants completed an anonymous online form that collected data on patient demographic s, state where patient lived, and a description of the case. Two physicians reviewed each submission and categorized the clinical scenario. Results We received 50 submissions detailing cases occurring between June 2022 and March 2023 among patients living in 14 states, including most of the states that had abortion bans in place. The scenarios involved cases of obstetric complications in the second trimester, including preterm prelabor rupture of membranes (sometimes complicated by infection), hemorrhage, cervical dilation, and hypertension, as well as ectopic pregnancy, underlying medical conditions complicating care, fetal anomalies, and early miscarriage, among others. The laws and their interpretations altered the standard of care in ways that contributed to delays, worsened health outcomes, and increased the cost and logistic complexity of care. Health care providers described feeling moral distress when they were unable to provide evidence-based care that put patients’ health at risk. Conclusions These findings document a wide range of harm occurring among people with the capacity for pregnancy in states with bans or severe restrictions on abortion care. Clinicians must be trusted to use their medical judgment to provide the best care to their patients and should not face the risk of being legally prosecuted for doing so. We aimed to document US healthcare providers’ reports of medical care that differed from the usual standard due to abortion restrictions enacted since the Dobbs v Jackson Women’s Health Organization decision. We solicited submissions through online and email networks of healthcare providers. Participants completed an anonymous online form that collected data on patient demographic s, state where patient lived, and a description of the case. Two physicians reviewed each submission and categorized the clinical scenario. We received 50 submissions detailing cases occurring between June 2022 and March 2023 among patients living in 14 states, including most of the states that had abortion bans in place. The scenarios involved cases of obstetric complications in the second trimester, including preterm prelabor rupture of membranes (sometimes complicated by infection), hemorrhage, cervical dilation, and hypertension, as well as ectopic pregnancy, underlying medical conditions complicating care, fetal anomalies, and early miscarriage, among others. The laws and their interpretations altered the standard of care in ways that contributed to delays, worsened health outcomes, and increased the cost and logistic complexity of care. Health care providers described feeling moral distress when they were unable to provide evidence-based care that put patients’ health at risk. These findings document a wide range of harm occurring among people with the capacity for pregnancy in states with bans or severe restrictions on abortion care. Clinicians must be trusted to use their medical judgment to provide the best care to their patients and should not face the risk of being legally prosecuted for doing so.

OBJECTIVE:Describe the prevalence of considering, wanting, and not obtaining a wanted abortion among a nationally representative sample of 15-44 year olds in the United States who had ever been pregnant. STUDY DESIGN:We analyzed data from ever-pregnant respondents (unweighted n = 1789) from a larger online survey about contraceptive access using the nationally representative AmeriSpeak panel. Among those not obtaining wanted abortions, weighted frequencies for sociodemographic characteristics and reasons for not getting the abortion are presented. RESULTS:Nearly 6% of the full sample reported having wanted an abortion they did not obtain. In open-ended responses, respondents most frequently reported individual reasons (43.8%) for not getting an abortion (e.g., changing their mind; personal opposition) and financial, logistical, or informational barriers (24.7%) likely related to policy. A quarter (24.1%) of the sample reported a past abortion. Among those who reported no past abortions, about one-fifth had considered abortion in the past, and 6.8% had wanted or needed one. Among those reporting no prior abortions who had considered abortion, only a third (34.3%) also report ever wanting or needing one. CONCLUSIONS:This study begins to quantify the experience, even before the Supreme Court's 2022 decision in Dobbs v. Jackson Women's Health Organization, of being unable to obtain a wanted abortion. Additionally, findings suggest that people in a national sample will answer questions about whether and why they did not obtain a wanted abortion. IMPLICATIONS:This study provides the first known national estimates of lifetime history of not getting a wanted abortion. Survey questions can be used for future research. Prospective and ongoing measurement of the inability to get a wanted abortion could be one part of documenting the effects of Dobbs on abortion access.

Objectives Coleman (2011) is a highly cited review article about the mental health effects of abortion that is commonly referenced outside academia by policymakers and jurists. While conclusions from this article do not match scientific consensus, the citation count has been used as evidence of scholarly legitimacy. Not all citations signify endorsement, however. We examine the citation patterns of Coleman (2011) over time to evaluate the claim of academic quality. Methods We retrieved all citations of the focal article from Google Scholar on December 7, 2022 (n=304). We excluded publications not written in English, not peer-reviewed, or those that listed the focal article in the works cited but not the text. Using qualitative content analysis, we coded each individual citation of Coleman as critical — established or raised concerns about the quality of the research — or uncritical — merely reported or endorsed the research findings. Inter-coder reliability exceeded 95%. Results Some 117 publications met our inclusion criteria, representing 174 individual citations of Coleman (2011): 33.9% of citations were critical, challenging Coleman’s conclusions or methodology. Critical citations peaked in 2014. Over time, the proportion of critical and uncritical citations has shifted: between 2018 and 2022, 86.4% of citations were uncritical. Conclusions The high proportion of critical citations of Coleman undercuts the premise that high citation counts convey legitimacy and problematizes the simplistic use of citation counts as evidence of academic quality. Findings reveal complexities in how scholarly research is understood and referenced in public, political and judicial discourse. The continuing uncritical citation of the focal article bears further investigation. Coleman (2011) is a highly cited review article about the mental health effects of abortion that is commonly referenced outside academia by policymakers and jurists. While conclusions from this article do not match scientific consensus, the citation count has been used as evidence of scholarly legitimacy. Not all citations signify endorsement, however. We examine the citation patterns of Coleman (2011) over time to evaluate the claim of academic quality. We retrieved all citations of the focal article from Google Scholar on December 7, 2022 (n=304). We excluded publications not written in English, not peer-reviewed, or those that listed the focal article in the works cited but not the text. Using qualitative content analysis, we coded each individual citation of Coleman as critical — established or raised concerns about the quality of the research — or uncritical — merely reported or endorsed the research findings. Inter-coder reliability exceeded 95%. Some 117 publications met our inclusion criteria, representing 174 individual citations of Coleman (2011): 33.9% of citations were critical, challenging Coleman’s conclusions or methodology. Critical citations peaked in 2014. Over time, the proportion of critical and uncritical citations has shifted: between 2018 and 2022, 86.4% of citations were uncritical. The high proportion of critical citations of Coleman undercuts the premise that high citation counts convey legitimacy and problematizes the simplistic use of citation counts as evidence of academic quality. Findings reveal complexities in how scholarly research is understood and referenced in public, political and judicial discourse. The continuing uncritical citation of the focal article bears further investigation.

Abortion is central to the American political landscape and a common pregnancy outcome, yet research on abortion has been siloed and marginalized in the social sciences. In an empirical analysis, the authors found only 22 articles published in this century in the top economics, political science, and sociology journals. This special issue aims to bring abortion research into a more generalist space, challenging what the authors term "the abortion research paradox," wherein abortion research is largely absent from prominent disciplinary social science journals but flourishes in interdisciplinary and specialized journals. After discussing the misconceptions that likely contribute to abortion research siloization and the implications of this siloization for abortion research as well as social science knowledge more generally, the authors introduce the articles in this special issue. Then, in a call for continued and expanded research on abortion, the introduction to this special issue closes by offering three guiding practices for abortion scholars-both those new to the topic and those deeply familiar with it-in the hopes of building an ever-richer body of literature on abortion politics, policy, and law. The need for such a robust literature is especially acute following the US Supreme Court's June 2022 overturning of the constitutional right to abortion.

Objectives: Pregnant people have traveled across state and national borders for the purpose of abortion since at least the 1960s. Scholarship has robustly documented the financial and logistical costs associated with travel, but less work has examined the emotional costs of abortion travel. We investigate whether abortion travel has emotional costs and, if so, how they come about.Study design: We conducted in-depth interviews with 30 women who had to travel across state borders in the United States for abortion care because of their gestation. We analyzed findings thematically. Results: Interviewees described having to travel to obtain abortion care as emotionally burdensome, caus-ing distress, stress, anxiety, and shame. Because they had to travel, they were compelled to disclose their abortion to others and obtain care in an unfamiliar place and away from usual networks of support, which engendered emotional costs. Additionally, travel induced feelings of shame and exclusion because it stemmed from a law-based denial of in-state abortion care, which some experienced as marking them as deviant or abnormal.Conclusions: People who have to travel for abortion care experience emotional costs alongside financial and logistical costs. The circumstances of that travel-specifically, being forced to travel because of legal restriction and service unavailability-are foundational to the ensuing emotional burdens. Findings add to the emerging literature on how laws and other structures produce the stigmatization of abortion at interpersonal and individual levels. Implications: With abortion bans following the overturning of the right to abortion and existing gesta-tional limits in the US, more people will have to travel for abortion care. Attention to the emotional costs of abortion travel can help providers understand what their patients may be experiencing when they present for care. (c) 2023 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ )