Reducing the burdens of forced abortion travel: Referrals, financial and emotional support, and opportunities for positive experiences in traveling for third-trimester abortion care

ObjectiveThe Massachusetts Access Program is a statewide, centralised referral and case management program created to address barriers to later second-trimester abortions. This study outlines the scope of, describes provider experiences with, and evaluates provider acceptability of the Program.Study designWe invited physicians, nurses and staff working in hospitals within the later abortion provider referral network to participate in a mixed-methods study that included a web-based quantitative survey and/or a semi-structured qualitative interview. We used descriptive statistics to analyse survey data and inductive coding methods to analyse interview data.ResultsFrom 2007–2012, 15–28% of abortions performed in Massachusetts at 19 weeks or greater gestational age annually were scheduled through the Access Program. We received 16 completed surveys and conducted seven interviews with providers who routinely receive referrals for later abortions through the Program. Providers overall reported positive experiences with the Program and found it highly acceptable. They described that the transportation, accommodation and financial assistance enabled patients access to care. The specialised and updated knowledge of the Access Coordinator in regards to abortion care also allowed her to act as a resource for providers.ConclusionsThe Access Program, through its referral and case management network, was a valuable resource both to patients seeking later second-trimester abortions and providers involved in abortion care. It acts as one example of an effective, highly acceptable and potentially replicable intervention to reduce barriers to obtaining later second-trimester abortions.

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Ambispective study on Mac Donald suturing in pregnant ladies with cervical incompetence in Dhulikhel Hospital

Kathmandu University Medical Journal ◽

10.3126/kumj.v8i3.6222 ◽

2012 ◽

Vol 8 (3) ◽

pp. 321-324

Author(s):

S R Tamrakur ◽

C D Chawla

Keyword(s):

Pregnant Women ◽

Pregnancy Outcomes ◽

Previous History ◽

Cervical Length ◽

University Teaching ◽

Third Trimester ◽

Cervical Cerclage ◽

Trimester Abortion ◽

Cervical Incompetence ◽

History Of

Background Cervical incompetence is one of the main contributors to repeated pregnancy loss, accounting for approximately 25% of the cases. Typically it results in progressive cervical dilatation, leading to a painless second- or early-third-trimester abortion. Objectives The main objective of the study was to explore the benefit from cervical cerclage in pregnant women with anatomical cervical incompetence Methods In a review of the operation and labour registers from January 2006 till January 2010, a total of 38 cervical cerclage procedures were performed at Dhulikhel Hospital (DH). In the study caste, parity, gestational age, diagnostic criteria, postoperative complications and pregnancy outcomes of the cases were analyzed. Results Two of the 38 cases didn’t come for delivery at Dhulikhel Hospital (Kathmandu University Teaching Hospital). Four women haven’t delivered at the time of data analysis. So pregnancy outcomes were analyzed among 32 cases while rests of the variables were analyzed among 38 cases. Of them 18 cases (47%) were Brahmin, 22 cases (58%) were between 20-25 years old and 32 cases (84%) were from Kavre district. All cases were booked cases (they had antenatal care in the hospital) and 14 patients (37%) were third gravida. Most cases had 2 to 4 antenatal visits prior to suturing. Two cases were diagnosed with a bicornuate uterus. 21 cases (55%) had a previous history of at least one dilatation and evacuation. 33 cases (87%) were diagnosed with cervical incompetence clinically and confirmed by ultrasound. The remaining 13% were assessed, in the absence of a history of mid-trimester abortion, of having a high suspicion of cervical incompetence after mid-trimester scan with measurement of cervical length. In 18 cases (47%), cervical cerclage were done at 15 to 20 weeks of gestation. The postoperative period was uneventful in all 38 cases. All cases (32) delivered in DH were assisted by consultant obstetricians. 19 out 32 cases (59%) were delivered vaginally at term. Conclusions38 cases were included in the study. Pregnancy outcomes were analyzed among 32 cases while rests of the variables were analyzed among 38 cases. 31 out 32 cases were delivered with good foetal weight. It clearly shows pregnant women with anatomical cervical incompetence were benefitted from cervical cerclage. The authors recommend an early trans vaginal scan in any patient with a history of mid trimester abortion or preterm labour. The cervical cerclage procedure therefore should be available more widely to benefit those patients with proven or strongly suspected cervical incompetence.DOI: http://dx.doi.org/10.3126/kumj.v8i3.6222 Kathmandu Univ Med J 2010;8(3):321-24

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Disruptions to Abortion Care in Louisiana During Early Months of the COVID-19 Pandemic

American Journal of Public Health ◽

10.2105/ajph.2021.306284 ◽

2021 ◽

pp. e1-e9

Author(s):

Sarah C. M. Roberts ◽

Nancy F. Berglas ◽

Rosalyn Schroeder ◽

Mary Lingwall ◽

Daniel Grossman ◽

...

Keyword(s):

Rate Ratio ◽

Incidence Rate Ratio ◽

Service Availability ◽

Second Trimester ◽

Trimester Abortion ◽

Abortion Care ◽

Before And After ◽

Second Trimester Abortion ◽

Service Data ◽

Abortion Clinics

Objectives. To examine changes in abortions in Louisiana before and after the COVID-19 pandemic onset and assess whether variations in abortion service availability during this time might explain observed changes. Methods. We collected monthly service data from abortion clinics in Louisiana and neighboring states among Louisiana residents (January 2018–May 2020) and assessed changes in abortions followin pandemic onset. We conducted mystery client calls to 30 abortion clinics in Louisiana and neighboring states (April–July 2020) and examined the percentage of open and scheduling clinics and median waits. Results. The number of abortions per month among Louisiana residents in Louisiana clinics decreased 31% (incidence rate ratio = 50.69; 95% confidence interval [CI] = 50.59, 0.79) from before to after pandemic onset, while the odds of having a second-trimester abortion increased (adjusted odds ratio [AOR] = 51.91; 95% CI = 51.10, 3.33). The decrease was not offset by an increase in out-of-state abortions. In Louisiana, only 1 or 2 (of 3) clinics were open (with a median wait >.2 weeks) through early May. Conclusions. The COVID-19 pandemic onset was associated with a significant decrease in the number of abortions and increase in the proportion of abortions provided in the second trimester among Louisiana residents. These changes followed service disruptions. (Am J Public Health. Published online ahead of print June 29, 2021: e1–e9. https://doi.org/10.2105/AJPH.2021.306284 )

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