EXPLAINED: Abortion Research & Policy Short Series

This series features short videos with experts highlighting the impact of abortion restrictions on women and providers in the United States. For more information, watch the extended lecture series and download the video companion materials.

EXPLAINED: Emotions Women Experience Post-Abortion in the United States

Corinne Rocca, PhD, MPH, of the University of California San Francisco, explains the emotions women express after having an abortion in the United States. Co-authors: Katrina Kimport, PhD; Heather Gould, MPH, John Neuhaus, PhD, Sarah Roberts, PhD, and Diana Greene Foster, PhD.

For more information, watch the extended lecture version and download the video companion materials.

The following sources provided the research used in this video:

Rocca CH, Kimport K, Gould H, Foster DG. Women’s emotions one week after receiving or being denied an abortion in the United States. Perspect Sex Reprod Health. 2013 Sep; 45(3):122-31. PMID: 24020773

Rocca CH, Kimport K, Roberts SC, Gould H, Neuhaus J, Foster DG. Decision rightness and emotional responses to abortion in the United States: A longitudinal study. PLOS One. 2015; 10(7):e0128832. PMID: 26154386.

For more resources, please visit the Turnaway study’s annotated bibliography.

EXPLAINED: Effects of Abortion on Women’s Mental Health

Dr. Antonia Biggs, of the University of California San Francisco, explains the most up-to-date research on the effects of abortion on women’s mental health.

For more information, watch the extended lecture version and download the video companion materials.

The following links provided the research used in this video:

_{Adler NE, David HP, Major BN, Roth SH, Russo NF, Wyatt GE. Psychological responses after abortion. 1990;248(4951):41-4.}

_{American Psychological Association Task Force on Mental Health and Abortion. Report of the APA Task Force on Mental Health and Abortion. Washington, DC: The American Psychological Association; 2008.}

_{Biggs MA, Gould H, Foster DG. Understanding why women seek abortions in the US. BMC Women’s Health. 2013;13(1):29.}

_{Biggs MA, Rowland B, McCulloch CE, Foster DG. Does abortion increase women’s risk for post-traumatic stress? Findings from a prospective longitudinal cohort study. BMJ Open. 2016;6(2):e009698.}

_{Biggs MA, Upadhyay UD, McCulloch CE, Foster DG. Women’s Mental Health and Well-being 5 Years After Receiving or Being Denied an Abortion: A Prospective, Longitudinal Cohort Study. JAMA Psychiatry. 2017;74(2):169-178.}

_{Biggs MA, Upadhyay UD, Steinberg JR, Foster DG. Does abortion reduce self-esteem and life satisfaction? Qual Life Res. 2014;23(9):2505-13.}

_{Charles VE, Polis CB, Sridhara SK, Blum RW. Abortion and long-term mental health outcomes: a systematic review of the evidence. Contraception. 2008;78(6):436-50.}

_{Foster DG, Steinberg JR, Roberts SC, Neuhaus J, Biggs MA. A comparison of depression and anxiety symptom trajectories between women who had an abortion and women denied one. Psychol Med. 2015:1-10.}

_{State policies in brief: Counseling and waiting periods for abortion. New York, NY: Guttmacher Institute; March 2016.}

_{Koop CE. A measured response: Koop on abortion. Fam Plann Perspect. 1989;21(1):31-2.}

_{National Collaborating Centre for Mental Health at the Royal College of Psychiatrists. Induced abortion and mental health: a systematic review of the mental health outcomes of induced abortion, including their prevalence and associated factors. London: Royal College of Psychiatrists; 2011.}

_{Robinson GE, Stotland NL, Nadelson CC. Abortion and mental health: guidelines for proper scientific conduct ignored. Br J Psychiatry. 2012;200(1):78-80.}

_{Robinson GE, Stotland NL, Russo NF, Lang JA, Occhiogrosso M. Is there an ‘abortion trauma syndrome’? Critiquing the evidence. Harv Rev Psychiatry. 2009;17(4):268-90.}

_{Steinberg JR, Finer LB. Examining the association of abortion history and current mental health: A reanalysis of the National Comorbidity Survey using a common-risk-factors model. Soc Sci Med. 2011;72(1):72-82.}

_{Steinberg JR, Finer LB. Coleman, Coyle, Shuping, and Rue make false statements and draw erroneous conclusions in analyses of abortion and mental health using the National Comorbidity Survey. J Psychiatr Res. 2012;46(3):407-11.}

_{Steinberg JR, Trussell J, Hall KS, Guthrie K. Fatal flaws in a recent meta-analysis on abortion and mental health. Contraception. 2012;86(5):430-7.}

_{Stotland NL. Induced abortion and adolescent mental health. Curr Opin Obstet. Gynecol. 2011;23(5):340-3.}

EXPLAINED: Impact of Restrictions on Clinical Practice

Dr. Carole Joffe, of the University of California San Francisco, explains the most up-to-date research on the impact of abortion restrictions on clinical practice.

For more information, watch the extended lecture version and download the video companion materials.

The following links provided the research used in this video:

_{Borgmann CE. Abortion Exceptionalism and Undue Burden Preemption. Washington and Lee Law Review. 2014;71(2).}

_{Joffe C. The Hidden Costs of Abortion Restrictions. Oct 15, 2014.}

_{Joffe C. Reflections on Whole Woman’s Health v. Hellerstedt: savoring victory, anticipating further challenges. 2016;94(5):436-438.}

_{Targeted Regulation of Abortion Providers. Guttmacher Institute; 2017.}

EXPLAINED: State Regulation of Medication Abortion

Dr. Ushma Upadhyay, of the University of California San Francisco, explains the most up-to-date research on the state regulation of medication abortion.

For more information, watch the extended lecture version and download the video companion materials.

The following links provided the research used in this video:

_{Boonstra HD. Medication Abortion Restrictions Burden Women and Providers—and Threaten U.S. Trend Toward Very Early Abortion. Guttmacher 2013.}

_{Chong E, Frye LJ, Castle J, Dean G, Kuehl L, Winikoff B. A prospective, non-randomized study of home use of mifepristone for medical abortion in the U.S. 2015;92(3):215-219.}

_{Clinical Practice Handbook for Safe Abortion. World Health Organization; 2014.}

_{Greene MF, Drazen JM. A New Label for Mifepristone. N Eng J Med. 2016;374(23):2281-2282.}

_{Grossman D, Grindlay K, Buchacker T, Lane K, Blanchard K. Effectiveness and acceptability of medical abortion provided through telemedicine. Obstet Gynecol. 2011;118(2 Pt 1):296-303.}

_{Grossman DA, Grindlay K, Buchacker T, Potter JE, Schmertmann CP. Changes in service delivery patterns after introduction of telemedicine provision of medical abortion in Iowa. Am J Public Health. 2013;103(1):73-78.}

_{Mitka M. Some men who take Viagra die–why? 2000;283(5):590, 593.}

_{NAF Protocol for Mifepristone/Misoprostol in Early Abortion in the U.S. National Abortion Federation; 2010.}

_{Ostapowicz G, Fontana RJ, Schiodt FV, et al. Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States. Ann Intern Med. 2002;137(12):947-954.}

_{Postmarket Drug Safety Information for Patients and Providers: Mifeprex (mifepristone) Information.S. Food and Drug Administration; 2016.}

_{Practice bulletin no. 143: medical management of first-trimester abortion. Obstet Gynecol. 2014;123(3):676-692.}

_{Spitz IM, Bardin CW, Benton L, Robbins A. Early pregnancy termination with mifepristone and misoprostol in the United States. N Eng J Med. 1998;338(18):1241-1247.}

_{Upadhyay UD, Desai S, Zlidar V, et al. Incidence of emergency department visits and complications after abortion. Obstet Gynecol. 2015;125(1):175-183.}

_{Upadhyay UD, Johns NE, Combellick SL, Kohn JE, Keder LM, Roberts SC. Comparison of Outcomes before and after Ohio’s Law Mandating Use of the FDA-Approved Protocol for Medication Abortion: A Retrospective Cohort Study. PLoS Med. 2016;13(8):e1002110.}

_{Winikoff B, Westhoff C. Fifteen years: looking back and looking forward. 2015;92(3):177-178.}

EXPLAINED: Who Can Safely Provide Abortion?

Dr. Monica McLemore, of the University of California San Francisco, explains the most up-to-date research on who can safely provide abortions.

For more information, watch the extended lecture version and download the video companion materials.

The following links provided the research used in this video:

_{Aztlan-James EA, McLemore M, Taylor D. Multiple Unintended Pregnancies in U.S. Women: A Systematic Review. Womens Health Issues.}

_{Freedman L, Battistelli MF, Gerdts C, McLemore M. Radical or routine? Nurse practitioners, nurse-midwives, and physician assistants as abortion providers. Reprod Health Matters. 2015;23(45):90-92.}

_{Health worker roles in providing safe abortion care and post-abortion contraception. World Health Organization (WHO); 2015.}

_{McLemore M, Levi A. Nurses and care of women seeking abortions, 1971 to 2011. J Obstet Gynecol Neonatal Nurs. 2011;40(6):672-677.}

_{McLemore MR, Desai S, Freedman L, James EA, Taylor D. Women know best–findings from a thematic analysis of 5,214 surveys of abortion care experience. Womens Health Issues. 2014;24(6):594-599.}

_{McLemore MR, Kools S, Levi AJ. Calculus formation: nurses’ decision-making in abortion-related care. Res Nurs Health. 2015;38(3):222-231.}

_{McLemore MR, Levi A, James EA. Recruitment and retention strategies for expert nurses in abortion care provision. 2015;91(6):474-479.}

_{Shattell M. Nurses Oppose Political Interference in Reproductive Health Care. March 2, 2016.}

_{Taylor D, Postlethwaite D, Desai S, et al. Multiple determinants of the abortion care experience: from the patient’s perspective. Am J Med Qual. 2013;28(6):510-518.}

_{Upadhyay UD, Desai S, Zlidar V, et al. Incidence of emergency department visits and complications after abortion. Obstet Gynecol. 2015;125(1):175-183.}

_{Weitz T, Anderson P, Taylor D. Advancing scope of practice for advanced practice clinicians: more than a matter of access. 2009;80(2):105-107.}

_{Weitz TA, Taylor D, Desai S, et al. Safety of aspiration abortion performed by nurse practitioners, certified nurse midwives, and physician assistants under a California legal waiver. Am J Public Health. 2013;103(3):454-461.}

_{Weitz TA, Taylor D, Upadhyay UD, Desai S, Battistelli M. Research informs abortion care policy change in California. Am J Public Health. 2014;104(10):e3-4.}

EXPLAINED: Abortion Safety in the United States

Dr. Dan Grossman, of the University of California San Francisco, explains the most up-to-date research on abortion safety in the United States.

For more information, watch the extended lecture version and download the video companion materials.

The following links provided the research used in this video:

_{Forouzanfar MH, et al. (2015). “Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.“}

_{Grimes DA, et al. (2006). “Unsafe abortion: the preventable pandemic.“}

_{Grossman D, et al. (2014). “Change in abortion services after implementation of a restrictive law in Texas.“}

_{Raymond EG and DA Grimes (2012). “The comparative safety of legal induced abortion and childbirth in the United States.“}

_{Raymond EG, et al. (2014). “Mortality of induced abortion, other outpatient surgical procedures and common activities in the United States.“}

_{Texas Policy Evaluation Project: Research Brief. (2016). “Change in number of physicians providing abortion care in Texas after HB2.“}

_{Upadhyay UD, et al. (2015). “Incidence of emergency department visits and complications after abortion.“}

_{Weitz T, et al. (2013). “Safety of aspiration abortion performed by nurse practitioners, certified nurse midwives, and physician assistants under a California legal waiver.“}

_{White K, et al. (2015). “Complications from first-trimester aspiration abortion: a systematic review of the literature.“}

_{White K, et al. (2016). “Women’s Knowledge of and Support for Abortion Restrictions in Texas: Findings from a Statewide Representative Survey.“}

EXPLAINED: Targeted Regulation of Abortion Providers

Dr. Dan Grossman, of the University of California San Francisco, explains the most up-to-date research on Targeted Regulation of Abortion Providers (TRAP Laws) in the United States.

For more information, watch the extended lecture version and download the video companion materials.

The following links provided the research used in this video:

_{Gerdts, C, et al. (2016). “Impact of Clinic Closures on Women Obtaining Abortion Services After Implementation of a Restrictive Law in Texas.“}

_{Grossman D, et al. (2014). “Change in abortion services after implementation of a restrictive law in Texas.“}

_{Texas Policy Evaluation Project: Research Brief. (2015). “Abortion wait times in Texas: The shrinking capacity of facilities and the potential impact of closing non-ASC clinics.”}

_{Upadhyay UD, et al. (2015). “Incidence of emergency department visits and complications after abortion.“}

_{White K, et al. (2015). “Complications from first-trimester aspiration abortion: a systematic review of the literature.“}

EXPLAINED: Turnaway Study

Dr. Diana Greene Foster, of the University of California San Francisco, explains the most up-to-date research from the Turnaway Study.

For more information, watch the extended lecture version and download the video companion materials.

The following links provided the research used in this video:

_{Roberts SCM, Gould H, Kimport K, Weitz TA, Foster DG. Out-of-Pocket Costs and Insurance Coverage for Abortion in the United States. March 2014. Women’s Health Issues, (24)2:3211-218.}

_{Biggs MA, Gould H, Foster DG. Understanding why women seek abortions in the US. July 2013. BMC Women’s Health, 13:29.}

_{Foster DG, Gerdts C, Korenman S, Ralph L, Roberts SCM. Effect of being denied a wanted abortion on women’s socioeconomic wellbeing. APHA abstract.}

_{Foster DG, Raifman S, Biggs MA. Effect of abortion receipt and denial on women’s existing and subsequent children. APHA abstract.}

_{For more information, review the annotated bibliography.}

EXPLAINED: Abortion On Screen

Gretchen Sisson and Katrina Kimport, of the University of California San Francisco, explain the most up-to-date research on abortion and it’s portrayal in film and television.

For more information, watch the extended lecture version and download the video companion materials.

The following links provided the research used in this video:

_{Sisson G, Kimport K. “Depicting abortion access on American television, 2005-2015.” Feminism and Psychology. [in press]}

_{Sisson G, Kimport K. “Doctors and Witches, Conscience and Violence: Abortion Provision on American Television.” Perspect Sex Reprod Health. 2016;48(4):161-8.}

_{Sisson G, Kimport K. “Telling stories about abortion: abortion-related plots in American film and television, 1916-2013.” Contraception. 2014;89(5):413-8.}

_{Sisson G, Kimport K. “Facts and fictions: Characters seeking abortion on American television, 2005-2014.” Contraception. 2016;93(5):446-51.}

EXPLAINED: Faith-Based Hospitals

Dr. Lori Freedman, of the University of California San Francisco, explains the most up-to-date research on abortion policy in faith-based hospitals.

For more information, watch the extended lecture version and download the video companion materials.

The following links provided the research used in this video:

_{Chan LM, Westhoff CL. “Tubal sterilization trends in the United States.” Fertil Steril. 2010;94(1):1-6.}

_{“Ethical and Religious Directives for Catholic Health Care Services.” United States Conference of Catholic Bishops; 2009.}

_{Freedman LR, Landy U, Steinauer J. “When there’s a heartbeat: miscarriage management in Catholic-owned hospitals.” Am J Public Health. 2008;98(10):1774-8.}

_{Freedman LR, Stulberg DB. “Conflicts in Care for Obstetric Complications in Catholic Hospitals.” AJOB Primary Research. 2013;4(4):1-10.}

_{Guiahi M, Sheeder J, Teal S. “Are women aware of religious restrictions on reproductive health at Catholic hospitals? A survey of women’s expectations and preferences for family planning care.” 2014;90(4):429-34.}

_{Guiahi M, Westhoff CL, Summers S, Kenton K. “Training at a faith-based institution matters for obstetrics and gynecology residents: results from a regional survey.” J Grad Med Educ. 2013;5(2):244-51.}

_{Stulberg DB, Dude AM, Dahlquist I, Curlin FA. “Obstetrician-gynecologists, religious institutions, and conflicts regarding patient-care policies.” Am J Obstet Gynecol. 2012;207(1):73.e1-5.}

_{Stulberg DB, Hoffman Y, Dahlquist IH, Freedman LR. “Tubal ligation in Catholic hospitals: a qualitative study of ob-gyns’ experiences.” Contraception. 2014;90(4):422-8.}

_{Stulberg DB, Jackson RA, Freedman LR. “Referrals for Services Prohibited In Catholic Health Care Facilities.” Perspect Sex Reprod Health. 2016;48(3):111-7.}

_{Uttley L, Reynertson S, Kenny L, Melling L. “Miscarriage of medicine: the growth of Catholic hospitals and the threat of reproductive health care.” The MergerWatch Project; the American Civil Liberties Union; 2013.}

_{Wall BM. “American Catholic hospitals: A century of changing markets and missions.” New Brunswick, N.J.: Rutgers University Press; 2011.}

EXPLAINED: Waiting Periods – Do Women Need More Time to Decide?

Dr. Sarah Roberts, of the University of California San Francisco, explains the most up-to-date research on abortion waiting periods in the United States.

For more information, watch the extended lecture version and download the video companion materials.

The following links provided the research used in this video:

_{Roberts SC, et al. (2016). “Women’s experiences with a 72-hour waiting period for abortion.”}

_{Roberts SC, et al. (2016). “Utah’s 72-Hour Waiting Period for Abortion: Experiences Among a Clinic-Based Sample of Women.“}

EXPLAINED: So-called “Abortion Reversal”

Dr. Monica McLemore, of the University of California San Francisco, explains what everyone needs to know about so-called “abortion reversal”.

To view more videos in our EXPLAINED series, visit the course page.

The following links provided the research used in this video:

_{Publications related to the Turnaway Study. (n.d.). Retrieved March 12, 2018, from https://www.ansirh.org/publications/turnaway}

EXPLAINED: Why Study Design Matters

Dr. Monica McLemore, of the University of California San Francisco, explains why the study design for so-called “abortion reversal” studies is problematic.

To view more videos in our EXPLAINED series, visit the course page.

EXPLAINED: Parental Involvement Requirements for Minors Seeking Abortion

Dr. Lauren Ralph, of the University of California San Francisco, explains the most up-to-date research on the requirements of parental involvement in minors seeking abortion.

For more information, watch the extended lecture version and download the video companion materials.

The following links provided the research used in this video:

_{_{Altindag O, Joyce T. Judicial Bypass for Minors Seeking Abortions in Arkansas Versus Other States. Am J Public Health. 2017;107(8):1266-1271.}}

_{_{Blum R, Resnick M, Stark T. The impact of a parental notification law on adolescent abortion decision making. Am J Public Health. 1987; 77:619-620.}}

_{_{Cartoof VG, Klerman LV. Parental consent for abortion: impact of the Massachusetts law. Am J Public Health. 1986;76:397-400.}}

_{_{Colman S, Joyce T, Kaestner R. Misclassification bias and the estimated effect of parental involvement laws on adolescents’ reproductive outcomes. Am J Public Health. 2008;98:1881-5.}}

_{_{Colman S, Joyce T. Minors’ behavioral responses to parental involvement laws: delaying abortion until age 18. Perspect Sex Reprod Health. 2009;41:119-26.}}

_{_{Dennis A, Henshaw SK, Joyce T, Finer LB, Blanchard K. The impact of laws requiring parental involvment for abortion: A literature review. New York, NY: Guttmacher Institute 2009.}}

_{_{Hasselbacher LA, Dekleva A, Tristan S, Gilliam ML. Factors influencing parental involvement among minors seeking an abortion: a qualitative study. Am J Public Health. 2014;104:2207-11}}

_{_{Henshaw SK, Kost K. Parental involvement in minors’ abortion decisions. Fam Plann Perspect. 1992;24:196-207, 13.}}

_{_{Joyce T, Kaestner R, Colman S. Changes in abortions and births and the Texas parental notification law. N Engl J Med. 2006;354:1031-8.}}

_{_{MacAfee L, Castle J, Theiler RN. Association between the New Hampshire parental notification law and minors undergoing abortions in northern New England. Obstet Gynecol. 2015;125:170-4}}

_{_{Parental Involvement in Minors Abortion: State Policies In Brief. New York, NY: Guttmacher Institute; 2018.}}

_{_{Ralph L, Gould H, Baker A, Foster DG. The role of parents and partners in minors’ decisions to have an abortion and anticipated coping after abortion. J Adolesc Health. 2014;54:428-34.}}

_{_{Ralph L, King E, Belusa E, Foster DG, Brindis CD, Biggs MA. The impact of a parental notification requirement on Illinois minors’ access to and decision-making around abortion. J Adolesc Health. 2018; March}}

_{_{Roberts SC, Gould H, Kimport K, Weitz TA, Foster DG. Out-of-pocket costs and insurance coverage for abortion in the United States. Womens Health Issues. 2014;24:e211-8.}}

_{_{Upadhyay UD, Weitz TA, Jones RK, Barar RE, Foster DG. Denial of abortion because of provider gestational age limits in the United States. Am J Public Health. 2014;104:1687-94.}}