Introduction: This study investigates women's experiences with Utah's 72-hour waiting period and two-

BackgroundSince mid-2013, Wisconsin abortion providers have been legally required to display and describe pre-abortion ultrasound images. We aimed to understand the impact of this law.MethodsWe used a mixed-methods study design at an abortion facility in Wisconsin. We abstracted data from medical charts one year before the law to one year after and used multivariable models, mediation/moderation analysis, and interrupted time series to assess the impact of the law, viewing, and decision certainty on likelihood of continuing the pregnancy. We conducted in-depth interviews with women in the post-law period about their ultrasound experience and analyzed them using elaborative and modified grounded theory.ResultsA total of 5342 charts were abstracted; 8.7% continued their pregnancies pre-law and 11.2% post-law (p = 0.002). A multivariable model confirmed the law was associated with higher odds of continuing pregnancy (aOR = 1.23, 95% CI: 1.01–1.50). Decision certainty (aOR = 6.39, 95% CI: 4.72–8.64) and having to pay fully out of pocket (aOR = 4.98, 95% CI: 3.86–6.41) were most strongly associated with continuing pregnancy. Ultrasound viewing fully mediated the relationship between the law and continuing pregnancy. Interrupted time series analyses found no significant effect of the law but may have been underpowered to detect such a small effect.Nineteen of twenty-three women interviewed viewed their ultrasound image. Most reported no impact on their abortion decision; five reported a temporary emotional impact or increased certainty about choosing abortion. Two women reported that viewing helped them decide to continue the pregnancy; both also described preexisting decision uncertainty.ConclusionsThis law caused an increase in viewing rates and a statistically significant but small increase in continuing pregnancy rates. However, the majority of women were certain of their abortion decision and the law did not change their decision. Other factors were more significant in women’s decision-making, suggesting evaluations of restrictive laws should take account of the broader social environment.

Illinois' PN requirement was associated with a decrease in the number of abortions among minors, delayed care for those from out-of-state, increased parental awareness of the pregnancy, and no change in parents' support.

Purpose: This paper examines how Utah's 72-hour waiting period and two-visit requirement influence women's certainty about their decision to have an abortion.Procedures: This study uses data from a prospective cohort study of 500 women who presented at an abortion information visit at four Utah family planning facilities. At the information visit, participants completed a baseline survey; three weeks later, they completed telephone interviews that assessed their pregnancy outcome, change in certainty, and an open-ended question about factors affecting changes in certainty.Main findings: Two-thirds (63%) reported no change in certainty due to the information visit and three-fourths (74%) reported no change in certainty due to the waiting period. Changes in certainty were primarily in the direction of increased certainty, with more than five times more women reporting an increase (29%) than a decrease (5%) in certainty due to the visit and two times more women reporting an increase (17%) than a decrease (8%) due to waiting. Changes in certainty were concentrated among the minority (8%) who were conflicted about their decision at baseline. Decreases in certainty due to waiting were concentrated among those who became less certain due to the visit. Learning about the procedure, meeting staff, and discovering that the facility was a safe medical environment were main contributors to increased certainty. Conclusion:As changes in certainty were concentrated among the small minority who were conflicted at the information visit and occurred due to the information visit, a universal waiting period does not appear appropriate.

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Objective To examine the pathways of care for abortion patients transferred or referred to emergency departments (EDs) or hospitals before and after abortion‐providing physicians obtained hospital admitting privileges. Data Sources This case series was based on retrospective chart review at three abortion clinics in which physicians had obtained admitting privileges in the previous 5 years. Study Design We identified patients who were transferred or referred to a hospital or ED. Patients were grouped according to the pathway by which their care was transferred or referred to the ED/hospital. Principal Findings Both before and after admitting privileges, the majority of patients were referred to a hospital before the abortion was attempted and most were for suspected ectopic pregnancy or to perform the abortion in a hospital. Direct ambulance transfer from the facility to the ED/hospital was the least common pathway. We observed few changes in practice from before to after admitting privileges. Preexisting mechanisms of coordination and communication facilitated care that was tailored for the specific patient. Conclusions We did not find evidence that physician admitting privileges influenced the pathways through which abortion patients obtain hospital‐based care, as existing mechanisms of collaboration between hospitals and abortion facilities allowed for management of patients who sought hospital‐based care.

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