Impact of a case management programme for women seeking later second-trimester abortion: the case of the Massachusetts Access Program

Ho, Stephanie; Janiak, Elizabeth

doi:10.1136/bmjsrh-2018-200095

Cited by 3 publications

(3 citation statements)

References 16 publications

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“…Inspired by the demonstrated efficacy of care navigation support in improving outcomes for gynecologic cancer, McKenney, Martinez, and Lee (2018) have identified the potential of care navigators to enhance access to care and promote selfefficacy for individuals seeking pregnancy termination. The Massachusetts Access Program, an abortion care navigation program for individuals with complex medical and social needs, has operated for more than a decade, providing information to up to 500 individuals and intensive case management to approximately 200 individuals seeking abortion annually (Ho & Janiak, 2018). A recent evaluation found the Access Program highly acceptable to abortion care providers, who report their patients benefit from the logistical assistance and patient education that the navigator provides (Ho & Janiak, 2018).…”

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confidence: 99%

Proposed Title X Regulatory Changes: Silencing Health Care Providers and Undermining Quality of Care

Janiak

O'Donnell

Holt

2018

Women's Health Issues

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Comprehensive information about treatment options and timely referrals to specialty services are essential to quality health care. In a striking new set of proposed changes to the federal Title X program, the Trump administration threatens the ability of health care providers to fulfill this key responsibility for low-income patients. Proposed regulatory changes would reverse a requirement that providers offer pregnant people served by the program "comprehensive, patient-centered counseling on their options" (i.e., prenatal, adoption, or abortion care as indicated) (U.S. Department of Health and Human Services, 2018) and would impose crippling restrictions on referral making.Originally created under the Nixon administration, Title X has historically enjoyed bipartisan support. Grant funds are awarded based on merit through an open application and rigorous review process. Along with patient education and outreach, Title X funds cover the cost of clinical family planning services for low-income uninsured and underinsured individuals. The funds finance contraceptive services, testing and treatment for sexually transmitted infections including human immunodeficiency virus, cancer screenings, and other preventive family planning care to 4 million Americans annually, and have never been used to pay for abortion services. The proposed new regulations forbid use of program funds in any facility that also separately provides abortions and proponents of this policy are clear that their primary objective is to prevent Planned Parenthood clinics from receiving Title X grants. Among health care providers who remain eligible for Title X funding, the provision of full-spectrum pregnancy options counseling and abortion referrals would be prohibited. The proposed regulations outright forbid health care providers from initiating an open conversation about all three options for an unanticipated pregnancy: parenting, adoption, and abortion. This proposed change represents a complete about facedaway from requiring high-quality, patient-centered information and counseling about options for continuing or terminating a pregnancy, toward requiring that providers withhold counseling and information. As noted by several leading physician and nursing organizations, such prohibitions on open communication between caregivers and patients could force Title X grant recipients to violate their conscience and breach professional ethics (

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confidence: 99%

Proposed Title X Regulatory Changes: Silencing Health Care Providers and Undermining Quality of Care

Janiak

O'Donnell

Holt

2018

Women's Health Issues

Self Cite

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“…Somewhat paradoxically, participants in our study also reported medical professionals to be a key source of information about abortion services [ 46 ]. As such, the medical system may act both to delay access to care for some, and as a valuable source of information for others [ 47 , 48 ].…”

Section: Discussionmentioning

confidence: 99%

Barriers and delays in access to abortion care: a cross-sectional study of people traveling to obtain care in England and the Netherlands from European countries where abortion is legal on broad grounds

Wollum,

De Zordo,

Zanini

et al. 2024

Reprod Health

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Introduction This study characterized the extent to which (1) financial barriers and (2) abortion care-seeking within a person’s country of residence were associated with delays in abortion access among those travelling to England and the Netherlands for abortion care from European countries where abortion is legal on broad grounds in the first trimester but where access past the first trimester is limited to specific circumstances. Methodology We drew on cross-sectional survey data collected at five abortion clinics in England and the Netherlands from 2017 to 2019 (n = 164). We assessed the relationship between difficulty paying for the abortion/travel, acute financial insecurity, and in-country care seeking on delays to abortion using multivariable discrete-time hazards models. Results Participants who reported facing both difficulty paying for the abortion procedure and/or travel and difficulty covering basic living costs in the last month reported longer delays in accessing care than those who had no financial difficulty (adjusted hazard odds ratio: 0.39 95% CI 0.21–0.74). This group delayed paying other expenses (39%) or sold something of value (13%) to fund their abortion, resulting in ~ 60% of those with financial difficulty reporting it took them over a week to raise the funds needed for their abortion. Having contacted or visited an abortion provider in the country of residence was associated with delays in presenting abroad for an abortion. Discussion These findings point to inequities in access to timely abortion care based on socioeconomic status. Legal time limits on abortion may intersect with individuals’ interactions with the health care system to delay care.

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“…Additionally, NYC Health + Hospitals created a new position of “Client Navigator,” following a successful model that was created in Massachusetts. 17 The Client Navigator’s primary role will be to accompany patients who need logistic or financial support through their abortion care experience, linking them to necessary resources and ensuring timely access to care. The Client Navigator will also support health care professionals both inside and outside the public health care system who are seeking referrals for their patients.…”

Section: Accessibilitymentioning

confidence: 99%

Addressing a Crisis in Abortion Access

Lynch

Mallow

Bodde

et al. 2022

Obstetrics &Amp; Gynecology

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Impact of a case management programme for women seeking later second-trimester abortion: the case of the Massachusetts Access Program

Cited by 3 publications

References 16 publications

Proposed Title X Regulatory Changes: Silencing Health Care Providers and Undermining Quality of Care

Proposed Title X Regulatory Changes: Silencing Health Care Providers and Undermining Quality of Care

Barriers and delays in access to abortion care: a cross-sectional study of people traveling to obtain care in England and the Netherlands from European countries where abortion is legal on broad grounds

Addressing a Crisis in Abortion Access

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