Research

Press Release: UW CORE Study Highlights Physicians’ Attitudes Toward Abortion; Research Brief Reveals Majority Support for Abortion Access

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New press release shares information from a CORE research brief. The study surveyed over 900 physicians, and found that many are concerned about abortion policies interfering in healthcare.

FOR IMMEDIATE RELEASE: November 17, 2021

CORE: The Collaborative for Reproductive Equity
University of Wisconsin-Madison

Contact: Samantha Herndon
smherndon@wisc.edu

608-285-2364

UW CORE Study Highlights Physicians’ Attitudes Toward Abortion: Research Brief Reveals Majority Support for Abortion Access

A new study by UW-Madison researchers documents overwhelming support of abortion services among faculty physicians at the UW School of Medicine and Public Health, with more than three-quarters of doctors expressing support for abortion access and more than nine in ten expressing concern about abortion restrictions. CORE, the UW Collaborative for Reproductive Equity, shares these findings in the research brief “Physician Support of Unrestricted Abortion Services in Wisconsin.”

The new research is part of a larger project that assessed abortion-related attitudes, practices, and perceptions among physicians of all specialties within a Wisconsin-based teaching hospital. The researchers surveyed 913 physicians who represent more than 20 medical specialties. The survey results showed:

  • More than three-quarters of physicians surveyed reported at least some degree of support for unrestricted access to abortion (78% said they support unrestricted abortion access somewhat or a lot).
  • 99% were at least a little concerned about legislation interfering in the doctor-patient relationship, and nearly half (48%) were extremely concerned.
  • Most doctors expressed at least some level of concern that abortion laws will make it difficult for physicians to offer timely and appropriate care (93%) and for patients to receive the care they need (91%).
  • Nine in ten doctors (90%) surveyed indicated that women’s health in Wisconsin would get worse if Roe v. Wade is overturned.

These findings underscore substantial physician concern that Wisconsin abortion restrictions can negatively affect patient care, the patient–provider relationship, and patients’ health.

CORE’s research suggests that Wisconsin’s abortion restrictions, which include (but are not limited to) a mandatory 24-hour waiting period, multiple clinically unnecessary constraints on medication abortion services, and the criminalization of abortion if Roe v. Wade is overturned, are not in line with physician’s professional perspectives. While doctors’ personal beliefs vary, the majority of doctors surveyed report that current abortion restrictions worsen patient care and that women’s health will decline further if abortion becomes illegal in our state.

 

UW CORE is an initiative within the School of Medicine and Public Health at the University of Wisconsin-Madison. CORE investigators conduct rigorous, interdisciplinary research focused on reproductive health, equity, and autonomy in Wisconsin, and beyond.

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New Brief: Wisconsin’s Proposed Changes to Reproductive Health Funding

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several patients wait in a clinic lobby

several patients wait in a clinic lobby

NEW CORE BRIEF: What would happen if reproductive healthcare providers were unable to participate in the Wisconsin Medicaid program?

Members of the Wisconsin state legislature recently passed new legislation that would prohibit healthcare organizations that perform abortions from being certified under the state’s Medical Assistance program.  This prohibition would mean that these clinics could not be reimbursed for other healthcare services provided to Wisconsinites as part of the state’s Medicaid program. Evidence suggests that this policy would have a negative impact on thousands of residents.

The bill is currently on the Governor’s desk.

What is the policy?
Existing Wisconsin state law already prohibits the use of any state, local, or federal funding to cover abortion care services except in limited circumstances. The proposed bill would add a major new level of restriction: it would prevent any healthcare organization that performs abortions from participating in the Medicaid program altogether. Most centrally, this ban would impact family planning clinics that provide abortion care, preventing them from seeking reimbursement from the Medicaid program for any of the reproductive health services they provide, not only abortion. Such vital services include contraception, sexually transmitted infection testing and treatment, and breast and cervical cancer screening.

Implications for Wisconsin
Research indicates that if Wisconsin state law were to prohibit healthcare providers that perform abortions from participating in the state Medicaid program, tens of thousands of Wisconsinites would lose access to essential reproductive healthcare services.

Read the full brief here, and check out our visual explainer on Instagram or Twitter.

Ending Abortion Access Will Have Significant Harmful Consequences for Individual and Families, CORE Researchers and Other Social Science Experts Tell Supreme Court

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Image from the Dobbs v. Jackson Women's Health Organization amicus brief submitted by Social Science Experts

The US Supreme Court has announced that it will hear the landmark abortion rights case Dobbs v. Jackson Women’s Health Organization beginning December 1, 2021, with a decision expected by June 2022. In response to the case, which could upend legal precedent that established that abortion is allowable until fetal viability at about 24 weeks, dozens of groups have filed amicus briefs for the nation’s high court to consider.

What is an amicus brief? An amicus brief is a legal term for written testimony provided by a ‘friend of the court,’ called an amicus curiae. These ‘friends’ can offer evidence or insight that will be important to consider in a legal case. Amicus briefs can be submitted by concerned individuals, scholars, states, medical professional associations, religious organizations, non-profits, and other groups. Briefs can be submitted in support of either the petitioners (in this case Thomas Dobbs, the State Health Officer of the Mississippi Department of Health) or in support of the respondents (in this case Jackson Women’s Health Organization—the last remaining reproductive health clinic that provides abortions in the state of Mississippi).

CORE Scholars and over one hundred other social science experts submitted an amicus brief to the Supreme Court in support of the respondents. The social scientists’ brief includes signers who have collectively spent decades conducting and publishing peer-reviewed research about the safety, incidence, social, psychological, and health impacts of unintended pregnancy and abortion in the United States. Their research has been published in hundreds of scientific articles which have appeared in leading medical and social science journals. Having extensively studied the effects of state restrictions on people seeking abortions, the researchers write that overturning the legal precedent that protects the Constitutional right to abortion will have harmful and significant consequences for individuals and families.

As the authors of significant studies on unwanted pregnancy and abortion in Mississippi and other restrictive settings, these scholars are deeply familiar with the consequences for families and individuals if abortion is no longer available. They have researched the impact of abortion restrictions and bans on healthcare delivery and find that many restrictions have far-reaching consequences. One highly-cited publication that was included in the brief was the CORE research article “Undue Burden Beyond Texas: An Analysis of Abortion Clinic Closures, Births, and Abortions in Wisconsin” by Dr. Joanna Venator and Dr. Jason Fletcher that found that closure of abortion clinics led to increased drives of over 100 miles to access abortion in some Wisconsin counties, in turn leading to lower abortion rates and higher birth rates. This limited access could constitute an undue burden, and violate the precedents set by Roe v. Wade (1973) and Casey v. Planned Parenthood (1992). The social science experts state that banning abortions after 15 weeks, as proposed by Dobbs and the state of Mississippi, will force people to travel out-of-state, increase costs, and prevent some from accessing abortion at all.

CORE faculty who signed the letter include Dr. Jenny A. Higgins, Dr. Nicholas Schmuhl, Dr. Jane Seymour, Dr. Daniela Mansbach, and Dr. Jason Fletcher.

The authors note that research has shown that pre-viability abortion bans harm, rather than improve, people’s health. In addition, social science research demonstrates that eliminating access to abortion has long-term negative socioeconomic consequences for women. Women who are denied an abortion are more likely to live below the poverty level and be unemployed years after being denied the abortion than people who receive their wanted abortion.

Read the full brief the social scientists submitted to the Supreme Court here.

New CORE study documents serious financial barriers to abortion care

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CORE researchers published an innovative new paper that finds that cost is of the largest obstacles to abortion care in the U.S. The new study was published in the International Journal of Environmental Research and Public Health.  The researchers studied the barriers to accessing abortion care for pregnant people through a novel method: by analyzing posts on the social media platform Reddit, which is used by over one-quarter of young adults in the U.S.

Findings from CORE’s new study underscore how overlapping barriers from funding to transportation and time off work create challenges for people who want or need abortion care. The obstacle of how to pay for an abortion and related costs is especially large in states such as Wisconsin—we are one of 33 states where Medicaid cannot be used to pay for abortion care, even though Medicaid does cover prenatal and birthing care costs.

The research team, which includes Jenny Higgins, MPH, PhD; Madison Lands, MSW, MPH; Taryn Valley, MS; Emma Carpenter, MSW, PhD; and Laura Jacques, MD, analyzed the 250 most recent Reddit posts that mentioned abortion. By studying what people posted to Reddit anonymously, instead of asking survey or interview questions, the researchers had a unique opportunity to learn about the questions and concerns that people face when considering an abortion before ever setting foot in a healthcare clinic.

CORE researchers identified four key themes of cost-related barriers to abortion:

  1. Inability to secure funds for abortion services and transportation
  2. Insufficient funds to select desired aspects of abortion services
  3. Insurance and administrative hurdles create unique barriers
  4. Relying on self-managed abortion options due to cost barriers

The following anonymous quote from the study illustrates Theme 4:

“I used Aid Access [an international mail-order service for medication abortion pills] to terminate my pregnancy because I couldn’t afford $500+ for the abortion counseling appointment and medical abortion. I didn’t qualify for aid because my finances look good on paper. But they don’t take into account your rent, health insurance, car payment, student loans, etc.”

Many other personal quotes in the study (see image below) illustrate the challenges that cost, long travel distances to clinics, abortion stigma, and other barriers create for people who need abortion services.

While some self-managed abortion methods, such as the medications mifepristone and misoprostol, are considered safe and effective, other methods may be harmful. The study’s results indicated that cost barriers lead some people to consider such illegal and potentially detrimental methods because they cannot afford medication or procedural abortion with a healthcare provider, due to lack of private or public insurance coverage for abortion services.

Results from this study contribute to growing evidence of the harmful effects of restrictions such as the Hyde Amendment, especially for people living on low incomes.

→ Read the full Cost-Related Barriers study here, and check out our research poster by CORE Research Manager Madison Lands below.

Schmuhl, Rice, Wautlet, and Higgins published in Contraception

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Front cover of the journal Contraception

The journal Contraception has published new research by UW-Madison’s Nicholas B. Schmuhl, PhD, Laurel W. Rice, MD, Cynthia K. Wautlet, MD, and Jenny A. Higgins, PhD. The article is part of a larger research project based at UW CORE, the Collaborative for Reproductive Equity. The authors’ objective was to assess abortion-related attitudes, practices, and perceptions among physicians of all specialties within a Wisconsin-based teaching hospital. 

The researchers surveyed 913 physicians at UW School of Medicine and Public Health. They found that 80% of physicians surveyed reported at least some degree of support for abortion access, and 84% of physicians surveyed reported at least some degree of support for physicians who provide abortions. Physicians who perceived less support for abortion among their peers also reported less willingness to consult in abortion-related care, regardless of specialty. In their article, the authors wrote:

“Our findings have implications for abortion care access and quality in Wisconsin, as well as professional quality of life for physicians who directly and indirectly participate in abortion care. These misperceptions have tangible consequences for access and quality of abortion care, as physicians who estimated relatively lower support among peers were less willing to consult in abortion-related cases. This discrepancy was greatest among specialties commonly associated with abortion care.”

Read the study here.

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Rural Wisconsin Women Expect Local Hospitals to Offer Full Range of Reproductive Services, Study Shows—But Many Catholic Hospitals Limit Patients’ Options

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photograph of a Catholic hospital

New CORE research, led by Dr. Renee D. Kramer and colleagues, sheds light on Wisconsin women’s expectations about whether they can access a range of reproductive healthcare options at a Catholic hospital—and whether those expectations are in line with their actual availability. Their latest article was published in the journal Contraception, titled “Expectations about Availability of Contraception and Abortion at a Hypothetical Catholic Hospital: Rural-Urban Disparities among Wisconsin Women.”

Catholic health systems are widespread in Wisconsin, and they can be the only health provider available for many rural residents. However, people may not know that their community hospital is Catholic owned or what healthcare services it prohibits.

Comparing the expectations of women in rural areas with the expectations of those in urban areas, Dr. Kramer and her coauthors highlighted several key findings from a survey of nearly 700 Wisconsinites:

  • While religious directives prohibit Catholic hospitals from providing birth control, sterilization, abortion, and emergency contraception, there are widespread misconceptions about their availability, particularly for women who live in rural areas.
  • Rural participants were about four times more likely as urban participants to expect to be able to receive the full range of contraceptive methods at Catholic healthcare systems.
    • For example, nearly three-quarters of rural-dwelling women (71%) expected to be able to obtain a tubal ligation, intrauterine device or implant, birth control shot, or birth control pill, compared to about half (47%) of urban-dwelling women.
  • Disparities were especially large for tubal ligation and long-acting reversible contraceptives—methods that other studies suggest are least-likely to be available in Catholic healthcare settings—which likely indicates a mismatch between patients’ expectations and service availability.

Wisconsin has a higher-than-average rural population and the nation’s single highest proportion of Catholic hospitals. It can be challenging for patients to find out what reproductive care is offered—or not offered—at their local hospitals. “Our findings that rural women are more likely to hold inaccurate expectations about available reproductive care suggest that rural women might be particularly at risk of presenting to a Catholic healthcare system only to be turned away from care,” Kramer and the research team said. “In order for prospective patients, especially in rural areas, to meet their reproductive health needs, they need readily accessible information to help them identify providers that can provide the desired services.”

Based on their findings, the researchers recommend that hospitals should be required to make it clear what services they do and do not offer. “Ultimately,” the authors write, “given the expanding influence of Catholic healthcare systems, large-scale investment in full-spectrum reproductive service providers—especially in rural areas—is needed to ensure timely access to care.”

Check out the full study in Contraception: https://go.wisc.edu/754h0q

Reddit data provides new source for exploring how people make decisions about their abortions – New AJOG Publication

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AJOG Researcher names and article information.

AJOG Researcher names and article information.

A new article published by CORE Researchers Laura Jacques, MD, Emma Carpenter, PhD, Taryn Valley, MA, Barbara Alvarez, MS, and Jenny Higgins, PhD, MPH was recently published in the prestigious American Journal of Obstetrics and Gynecology. The authors innovatively studied Reddit users to cast a revealing light on the barriers facing people as they choose whether to have an in-clinic abortion or a pill abortion at home. The article is titled, “Medication or surgical abortion? An exploratory study of patient decision making on a popular social media platform.” The researchers analyzed Reddit users’ posts about their abortion experiences, revealing four key themes:

  • Structural Barriers, such as concerns about cost and transportation;
  • Emotional Experiences, such as desiring the support of the clinic staff in cases where a pregnant person did not have family or friend support;
  • Pregnancy Profiles, such as when someone has an underlying medical condition;
  • Process-Specific Concerns, such as the length of the appointment.

Reddit, a website used by nearly a quarter of US-based young adults, with over two million user-created message boards, provides a unique source of information. Online anonymity may make the internet appealing for those seeking abortion information, and anonymity is a key feature of Reddit. The researchers approach made it possible to study people’s decision making before they ever have an abortion; most research to-date focuses on people who have already had a procedural or pill abortion.

Barring specific medical reasons in the first trimester, people can select the abortion method that feels most comfortable to them. An in-clinic abortion involves a brief procedure and is often performed in outpatient clinics. A pill abortion can be accomplished in people’s own home, but in many states, including Wisconsin, patients are required to make one or more visits to a clinic to obtain medications and/or follow-up care. Some Reddit users expressed a preference for being in a health clinic setting with professional providers present, while others wanted the privacy of their own homes.

The novel use of social media as a source of information about patient decision making offers a unique opportunity for researchers to capture the thoughts and experiences of people who have not yet or may never make it to a clinic. The study presents a new source of data for researchers going forward that can inform abortion policy, information, and provision of care.

Read the full study in the American Journal of Obstetrics and Gynecology here.

Press Release: Reddit yields new information about how people make personal decisions about abortion—and how the internet shapes their decisions

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Press Release: Reddit yields new information about how people make personal decisions about abortion—and how the internet shapes their decisions (6/30/2021)

FOR IMMEDIATE RELEASE: June 30, 2021
CORE: The Collaborative for Reproductive Equity
University of Wisconsin-Madison

Contact: Samantha Herndon
smherndon@wisc.edu

608-285-2364

Press Release: Reddit yields new information about how people make personal decisions about abortion—and how the internet shapes their decisions

A new article published by a team of researchers at the UW-Madison Collaborative for Reproductive Equity (CORE) innovatively studied Reddit users to cast a revealing light on the barriers facing people as they choose whether to have an in-clinic abortion or a pill abortion at home. The study, published in the prestigious American Journal of Obstetrics and Gynecology, studied Reddit users’ posts about their abortion experiences, revealing four key themes:

  • Structural Barriers, such as concerns about cost and transportation;
  • Emotional Experiences, such as desiring the support of the clinic staff in cases where a pregnant person did not have family or friend support;
  • Pregnancy Profiles, such as when someone has an underlying medical condition;
  • Process-Specific Concerns, such as the length of the appointment.

CORE Researchers Laura Jacques, MD, Emma Carpenter, PhD, Taryn Valley, MA, Barbara Alvarez, MS, and Jenny Higgins, PhD, MPH turned to Reddit to better understand how pregnant people who want an abortion decide what type of abortion care to choose. Reddit, a website used by nearly a quarter of US-based young adults, with over two million user-created message boards, provides a unique source of information. Online anonymity may make the internet appealing for those seeking abortion information, and anonymity is a key feature of Reddit.

Barring specific medical reasons in the first trimester, people can select the abortion method that feels most comfortable to them. An in-clinic abortion involves a brief procedure and is often performed in outpatient clinics. A pill abortion can be accomplished in people’s own home, but in many states, including Wisconsin, patients are required to make one or more visits to a clinic to obtain medications and/or follow-up care. Some Reddit users expressed a preference for being in a health clinic setting with professional providers present, while others wanted the privacy of their own homes.

The novel use of social media as a source of information about patient decision making offers a unique opportunity for researchers to capture the thoughts and experiences of people who have not yet or may never make it to a clinic. The study presents a new source of data for researchers going forward that can inform abortion policy, information, and provision of care.

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The Collaborative for Reproductive Equity (CORE) is an initiative within the School of Medicine and Public Health at the University of Wisconsin-Madison. CORE investigators conduct rigorous, interdisciplinary research focused on reproductive health, equity, and autonomy in Wisconsin, and beyond. Visit core.wisc.edu to learn more about our research.

Reproductive Health Impact Study: Wisconsin Data Shows Decrease in Number of Contraceptive Patients Served by Title X-Funded Clinics

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Changes in number of Title-X family planning clinics in Wisconsin

Researchers at the Guttmacher Institute, a leading research and policy organization committed to advancing sexual and reproductive health and rights, have been working on a multiyear state-based study, and Wisconsin is one of the states on which they are focusing. In collaboration with UW CORE and other Wisconsin research and policy partners, Guttmacher Institute investigators analyzed the effects of federal and state policy changes on publicly funded reproductive healthcare between 2017 and today. These Reproductive Health Impact Studies (RHIS) also include Arizona, New Jersey, and Iowa.

Reproductive Health Impact Study: Wisconsin Fact Sheet

By Ruth Dawson, Jennifer Frost and Megan Kavanaugh

The fact sheets include state policy background, key reproductive health indicators and details about the state’s publicly funded family planning network. Information on the impacts of COVID-19 on reproductive health care is also available. Researchers found that the COVID-19 pandemic has led to significant interruptions in patients’ ability to access family planning—particularly for those who rely on publicly funded clinics. For example, data from the study shows that 33% of patients surveyed reported having to delay, skip, or cancel visiting their doctor or clinic for sexual and reproductive healthcare as a result of the pandemic.

Impact of the Covid-19 pandemic on access to sexual and reproductive health care in Wisconsin

The project’s objective is to illuminate the effects of policy change from a number of different angles: Wisconsin’s Family planning landscape, clinics, clinic staff, patients, and reproductive health indicators.

Click here for the full study: RHIS Wisconsin Fact Sheet