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Realizing the Full Decriminalization of Abortion: A Comprehensive Approach Through Public Health and International Human Rights Law

October 4, 2023

Over the past few decades, there has been mounting consensus within the international human rights and public health communities that restrictive abortion laws violate a range of fundamental human rights and are detrimental to individuals' health and well-being. Indeed, human rights bodies have taken steadily more progressive stances on abortion, and global public health entities also increasingly recognize that abortion is a public health need. Centering sexual and reproductive health and rights, and abortion specifically, in discussions of strengthening health systems presents opportunities to expand support for abortion rights. This article integrates evidence from three perspectives—demographic, health and legal—to present arguments for the liberalization of abortion laws that are more compelling than each perspective alone. Drawing on human rights law and updated evidence on abortion, the article demonstrates that the criminalization of abortion creates significant barriers to accessing legal abortion services by generating stigma, failing to guarantee patients' confidentiality, and disproportionally impacting marginalized and rural communities. To guarantee access to abortion services free from stigma, and in accordance with human rights, states must remove all abortion provisions from the penal code and incorporate abortion regulations within health codes, as done for other medical procedures. Both full decriminalization of abortion and health system policy reforms, with a particular emphasis on reaching vulnerable groups, are essential for all people to fully realize their right to make autonomous reproductive health decisions and to have access to the information and services necessary to achieve this right free from discrimination, coercion, and violence.

How Universal Health Coverage Can Increase Access to Sexual and Reproductive Health Services in Sub-Saharan Africa

July 1, 2023

KEY POINTSIn recent years, governments across Africa have sought to shield theirpopulations from the high financial cost of health care by implementinguniversal health coverage schemes.Universal health coverage cannot be achieved unless comprehensive sexualand reproductive health (SRH) care is included in national health plans.Kenya, Ghana, Ethiopia and Benin offer examples of how to integrate SRHinto broader health coverage plans.Recommendations are offered to inform stakeholders' approach tointegrating sexual and reproductive health care into national healthcoverage plans.

Primary and reproductive healthcare access and use among reproductive aged women and female family planning patients in 3 states

May 24, 2023

Public funding plays a key role in reducing cost barriers to sexual and reproductive health (SRH) care in the United States. In this analysis, we examine sociodemographic and healthcare seeking profiles of individuals in three states where public funding for health services has recently changed: Arizona, Iowa, and Wisconsin. In addition, we examine associations between individuals' health insurance status and whether they experienced delays or had trouble in obtaining their preferred contraception. This descriptive study draws on data collected between 2018 to 2021 in two distinct cross-sectional surveys in each state, one among a representative sample of female residents aged 18–44 and the other among a representative sample of female patients ages eighteen and older seeking family planning services at healthcare sites that receive public funding to deliver this care. The majority of reproductive-aged women and female family planning patients across states reported having a personal healthcare provider, had received at least one SRH service in the preceding 12 months, and were using a method of birth control. Between 49–81% across groups reported receiving recent person-centered contraceptive care. At least one-fifth of each group reported wanting healthcare in the past year but not getting it, and between 10–19% reported a delay or trouble getting birth control in the past 12 months. Common reasons for these outcomes involved cost and insurance-related issues, as well as logistical ones. Among all populations except Wisconsin family planning clinic patients, those with no health insurance had greater odds of being delayed or having trouble getting desired birth control in the past 12 months than those with health insurance. These data serve as a baseline to monitor access and use of SRH services in Arizona, Wisconsin, Iowa in the wake of drastic family planning funding shifts that changed the availability and capacity of the family planning service infrastructure across the country. Continuing to monitor these SRH metrics is critical to understand the potential effect of current political shifts.

One Month Post-Roe: At Least 43 Abortion Clinics Across 11 States Have Stopped Offering Abortion Care

July 28, 2022

In the first month following the US Supreme Court's decision to overturn Roe v. Wade, 11 states–all in the South and Midwest–had banned abortion completely or implemented a six-week ban. Our latest research shows that by July 24, the number of clinics offering abortions in these 11 states dropped by 43, from 71 to 28. These clinic closures will further deepen inequities in access to care.

Interactive Map: US Abortion Policies and Access After Roe

June 28, 2022

The abortion landscape is fragmented and increasingly polarized. Many states have abortion restrictions or bans in place that make it difficult, if not impossible, for people to get care. Other states have taken steps to protect abortion rights and access. To help people understand this complex landscape, our interactive map groups states into one of seven categories based on abortion policies they currently have in effect. Users can select any state to see details about abortion policies in place, characteristics of state residents and key abortion statistics, including driving distance to the nearest abortion clinic.

Long-Term Decline in US Abortions Reverses, Showing Rising Need for Abortion as Supreme Court Is Poised to Overturn Roe v. Wade

June 15, 2022

The long-term decline in abortions in the United States that started 30 years ago has reversed, according to new data from the Guttmacher Institute--underscoring that the need for abortion care in the United States is growing just as the US Supreme Court appears likely to overturn or gut Roe v. Wade.According to new findings from Guttmacher's latest Abortion Provider Census--the most comprehensive data collection effort on abortion provision in the United States--there were 8% more abortions in 2020 than in 2017.

New Analyses on US Immigrant Health Care Access Underscore the Need to Eliminate Discriminatory Policies

May 18, 2022

Previous Guttmacher Institute research has described sexual and reproductive health disparities between immigrant women and their US-born counterparts. We present new analyses, based on two nationally representative surveys, that show inequities in health insurance coverage by citizenship status and race or ethnicity, and health care service use by citizenship status. These new findings are consistent with existing evidence indicating a need for policies to eliminate sexual and reproductive health inequities that have long persisted along lines of race and ethnicity, immigration status and income in the United States.These analyses make it clear that policymakers need to address these inequities. Two bills, the Health Equity and Access Under the Law (HEAL) for Immigrant Families Act and the Lifting Immigrant Families Through Benefits Access Restoration (LIFT the BAR) Act, represent opportunities to do just that.

Unintended Pregnancy and Abortion in Northern America

March 24, 2022

Model-based estimates offer an opportunity to observe and assess unintended pregnancy and abortion over time and, because they enable comparability across borders and groups, to do so for individual countries, for regions and globally. Estimates for regions and subregions, as defined by the United Nations Statistics Division groupings, can offer advocates, policymakers, researchers and others valuable insight into sexual and reproductive health and autonomy. Regional estimates can help reveal disparities and areas where continued investment is needed to ensure that individuals can access the full spectrum of quality sexual and reproductive health care.The estimates below provide an overview of the incidence of unintended pregnancy and abortion in Northern America from 1990 through 2019; the values are based on average annual estimates for five-year time periods. View these estimates in country profiles on guttmacher.org.

Cross-state travel for abortion care

March 17, 2022

Abortion access in the United States is limited for people who live in states with hostile abortion restrictions, pushing some to travel out of state to receive care. Our experts commented on a study by Mikaela H. Smith and colleagues that used data from Guttmacher and the Centers for Disease Control and Prevention to examine the frequency with which people cross state lines for abortion care.Building on Smith and colleagues' findings, Guttmacher experts used data from our previously published analysis of travel distance to the nearest abortion clinic to examine the proportion of women whose nearest provider was in another state and the proportion of patients who received care out of state. In states with hostile abortion legislation, there is a high correlation between the proportion of women whose nearest provider was in another state and the proportion who obtained out-of-state care not found in a state with supportive abortion policies. As state restrictions on abortion intensify and Roe v. Wade is threatened by the upcoming US Supreme Court decision in Dobbs v. Jackson Women's Health Organization, more patients may be forced to travel out of state and even beyond bordering states to access abortion care.

Medication Abortion Now Accounts for More Than Half of All US Abortions

February 24, 2022

In 2000, the US Food and Drug Administration (FDA) approved mifepristone as a method of abortion. Taken along with misoprostol, the two-drug combination is known as medication abortion or the "abortion pill." New research from the Guttmacher Institute shows that 20 years after its introduction, medication abortion accounted for more than half of all abortions in the United States.Specifically, preliminary data from the Guttmacher Institute's periodic census of all known abortion providers show that in 2020, medication abortion accounted for 54% of US abortions. That year is the first time medication abortion crossed the threshold to become the majority of all abortions and it is a significant jump from 39% in 2017, when Guttmacher last reported these data. This 54% estimate is based on preliminary findings from ongoing data collection; final estimates will be released in late 2022 and the proportion for medication abortion use is not expected to fall below 50%.This new data point powerfully illustrates that medication abortion has gained broad acceptance from both abortion patients and providers. It also underscores how central this method has become to US abortion provision, thanks to its track record of safe and effective use for more than two decades. As medication abortion has become the most common method of abortion, there is still the potential to further increase access—which is why the method has become a main target of anti-abortion politicians and activists seeking to restrict care.

The Continuing Impacts of the COVID-19 Pandemic in the United States: Findings from the 2021 Guttmacher Survey of Reproductive Health Experiences

December 7, 2021

The COVID-19 pandemic is a public health crisis with major ramifications for people's personal lives, including their sexual and reproductive health. In early May 2020, we surveyed a national sample of cisgender women in the 2020 Guttmacher Survey of Reproductive Health Experiences (GSRHE). We found that just a few months into the COVID-19 pandemic, there were profound changes to respondents' sexual and reproductive health goals and behaviors and their access to care.1 Other early studies validated these findings.2,3 Since May 2020, the course and impact of the pandemic have shifted, due to vaccination rates, new variants and relaxed restrictions. To provide an updated look at the ongoing impact of the pandemic on sexual and reproductive health, we fielded another national survey during July and August of 2021. The 2021 GSRHE had a substantially larger sample size than the previous one and was designed to include individuals with a broader range of gender identities. The expanded sample allows us to examine variations in several new, key areas, including gender identity, Asian and Pacific Islander racial identity, and the intersection of race and income.In this report, we analyze the 2021 data, focusing on how respondents feel the COVID-19 pandemic has influenced their sexual and reproductive health in two core areas: fertility preferences and access to care, including use of telehealth. We note disparities according to individuals' race and ethnicity, sexual orientation, gender identity, income level and economic well-being. To assess the ongoing scope and magnitude of the impacts of the pandemic, we also examine findings on comparable measures from the 2020 and 2021 GSRHE studies.

Abortion Policy in the Absence of Roe

December 1, 2021

Changes to the makeup of the U.S. Supreme Court in 2018 raise the possibility that Roe v. Wade could be severely undermined—or even overturned—essentially leaving the legality of abortion to individual states. A reversal of Roe could establish a legal path for states' pre-1973 abortion bans, as well as currently unenforced post-1973 bans, to take effect.