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Published in: BMC Women's Health 1/2019

Open Access 01-12-2019 | Prenatal Care | Research article

Estimating the proportion of Medicaid-eligible pregnant women in Louisiana who do not get abortions when Medicaid does not cover abortion

Authors: Sarah C. M. Roberts, Nicole E. Johns, Valerie Williams, Erin Wingo, Ushma D. Upadhyay

Published in: BMC Women's Health | Issue 1/2019

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Abstract

Background

To estimate the proportion of pregnant women in Louisiana who do not obtain abortions because Medicaid does not cover abortion.

Methods

Two hundred sixty nine women presenting at first prenatal visits in Southern Louisiana, 2015–2017, completed self-administered iPad surveys and structured interviews. Women reporting having considered abortion were asked whether Medicaid not paying for abortion was a reason they had not had an abortion. Using study data and published estimates of births, abortions, and Medicaid-covered births in Louisiana, we projected the proportion of Medicaid births that would instead be abortions if Medicaid covered abortion in Louisiana.

Results

28% considered abortion. Among women with Medicaid, 7.2% [95% CI 4.1–12.3] reported Medicaid not paying as a reason they did not have an abortion. Existing estimates suggest 10% of Louisiana pregnancies end in abortion. If Medicaid covered abortion, this would increase to 14% [95% CI 12, 16]. 29% [95% CI 19, 41] of Medicaid eligible pregnant women who would have an abortion with Medicaid coverage, instead give birth.

Conclusions

For a substantial proportion of pregnant women in Louisiana, the lack of Medicaid funding remains an insurmountable barrier to obtaining an abortion. Forty years after the Hyde Amendment was passed, lack of Medicaid funding for abortion continues to have substantial impacts on women’s ability to obtain abortions.
Literature
1.
go back to reference Adashi EY, Occhiogrosso RH. The Hyde amendment at 40 years and reproductive rights in the United States: perennial and panoptic. JAMA. 2017;317(15):1523–4.CrossRef Adashi EY, Occhiogrosso RH. The Hyde amendment at 40 years and reproductive rights in the United States: perennial and panoptic. JAMA. 2017;317(15):1523–4.CrossRef
3.
go back to reference Nash E, Gold RB, Mohammed L, Ansari-Thomas Z, Cappello O. Policy trends in the states, vol. 2017. New York: Guttmacher Institute; 2018. Nash E, Gold RB, Mohammed L, Ansari-Thomas Z, Cappello O. Policy trends in the states, vol. 2017. New York: Guttmacher Institute; 2018.
6.
go back to reference Jerman J, Jones RK, Onda T. Characteristics of U.S. abortion patients in 2014 and changes since 2008. New York: Guttmacher Institute; 2016. Jerman J, Jones RK, Onda T. Characteristics of U.S. abortion patients in 2014 and changes since 2008. New York: Guttmacher Institute; 2016.
7.
go back to reference Roberts SC, Gould H, Kimport K, Weitz TA, Foster DG. Out-of-pocket costs and insurance coverage for abortion in the United States. Womens Health Issues. 2014;24(2):e211–8.CrossRef Roberts SC, Gould H, Kimport K, Weitz TA, Foster DG. Out-of-pocket costs and insurance coverage for abortion in the United States. Womens Health Issues. 2014;24(2):e211–8.CrossRef
8.
go back to reference Jones RK, Upadhyay UD, Weitz TA. At what cost? Payment for abortion care by U.S. women. Womens Health Issues. 2013;23(3):e173–8.CrossRef Jones RK, Upadhyay UD, Weitz TA. At what cost? Payment for abortion care by U.S. women. Womens Health Issues. 2013;23(3):e173–8.CrossRef
9.
go back to reference Henshaw SK, Joyce TJ, Dennis A, Finer LB, Blanchard K. Restrictions on Medicaid funding for abortions: a literature review. New York: Guttmacher Institute; 2009. Henshaw SK, Joyce TJ, Dennis A, Finer LB, Blanchard K. Restrictions on Medicaid funding for abortions: a literature review. New York: Guttmacher Institute; 2009.
10.
go back to reference Jarlenski M, Hutcheon JA, Bodnar LM, Simhan HN. State Medicaid coverage of medically necessary abortions and severe maternal morbidity and maternal mortality. Obstet Gynecol. 2017;129(5):786–94.CrossRef Jarlenski M, Hutcheon JA, Bodnar LM, Simhan HN. State Medicaid coverage of medically necessary abortions and severe maternal morbidity and maternal mortality. Obstet Gynecol. 2017;129(5):786–94.CrossRef
11.
go back to reference Krieger N, Gruskin S, Singh N, Kiang MV, Chen JT, Waterman PD, Beckfield J, Coull BA. Reproductive justice & preventable deaths: state funding, family planning, abortion, and infant mortality, US 1980-2010. SSM Popul Health. 2016;2:277–93.CrossRef Krieger N, Gruskin S, Singh N, Kiang MV, Chen JT, Waterman PD, Beckfield J, Coull BA. Reproductive justice & preventable deaths: state funding, family planning, abortion, and infant mortality, US 1980-2010. SSM Popul Health. 2016;2:277–93.CrossRef
12.
go back to reference Dennis A, Manski R, Blanchard K. A qualitative exploration of low-income Women's experiences accessing abortion in Massachusetts. Womens Health Issues. 2015;25(5):463–9.CrossRef Dennis A, Manski R, Blanchard K. A qualitative exploration of low-income Women's experiences accessing abortion in Massachusetts. Womens Health Issues. 2015;25(5):463–9.CrossRef
13.
go back to reference Dennis A, Blanchard K. Abortion providers' experiences with Medicaid abortion coverage policies: a qualitative multistate study. Health Serv Res. 2013;48(1):236–52.CrossRef Dennis A, Blanchard K. Abortion providers' experiences with Medicaid abortion coverage policies: a qualitative multistate study. Health Serv Res. 2013;48(1):236–52.CrossRef
14.
go back to reference Dennis A, Blanchard K, Cordova D. Strategies for securing funding for abortion under the Hyde amendment: a multistate study of abortion providers' experiences managing Medicaid. Am J Public Health. 2011;101(11):2124–9.CrossRef Dennis A, Blanchard K, Cordova D. Strategies for securing funding for abortion under the Hyde amendment: a multistate study of abortion providers' experiences managing Medicaid. Am J Public Health. 2011;101(11):2124–9.CrossRef
15.
go back to reference Dennis A, Manski R, Blanchard K. Does medicaid coverage matter?: a qualitative multi-state study of abortion affordability for low-income women. J Health Care Poor Underserved. 2014;25(4):1571–85.CrossRef Dennis A, Manski R, Blanchard K. Does medicaid coverage matter?: a qualitative multi-state study of abortion affordability for low-income women. J Health Care Poor Underserved. 2014;25(4):1571–85.CrossRef
17.
go back to reference Roberts SCM, Kimport K, Kriz R, Holl J, Mark K, Williams V. Consideration of and reasons for not obtaining abortion among women entering prenatal care in southern Louisiana and Baltimore, Maryland. Sex Res Social Policy 2018. Epub ahead of print. Roberts SCM, Kimport K, Kriz R, Holl J, Mark K, Williams V. Consideration of and reasons for not obtaining abortion among women entering prenatal care in southern Louisiana and Baltimore, Maryland. Sex Res Social Policy 2018. Epub ahead of print.
18.
go back to reference Jones RK, Kooistra K. Abortion incidence and access to services in the United States, 2008. Perspect Sex Reprod Health. 2011;43(1):41–50.CrossRef Jones RK, Kooistra K. Abortion incidence and access to services in the United States, 2008. Perspect Sex Reprod Health. 2011;43(1):41–50.CrossRef
19.
go back to reference Towey S, Poggi S, Roth R. Abortion funding: a matter of justice. Report. Boston, MA: The National Network of Abortion Funds; 2005. Towey S, Poggi S, Roth R. Abortion funding: a matter of justice. Report. Boston, MA: The National Network of Abortion Funds; 2005.
20.
go back to reference Jones RK, Ingerick M, Jerman J. Differences in abortion service delivery in hostile, middle-ground, and supportive states in 2014. Womens Health Issues. 2018;28(3):212–8.CrossRef Jones RK, Ingerick M, Jerman J. Differences in abortion service delivery in hostile, middle-ground, and supportive states in 2014. Womens Health Issues. 2018;28(3):212–8.CrossRef
22.
go back to reference Barrett G, Smith SC, Wellings K. Conceptualisation, development, and evaluation of a measure of unplanned pregnancy. J Epidemiol Community Health. 2004;58(5):426–33.CrossRef Barrett G, Smith SC, Wellings K. Conceptualisation, development, and evaluation of a measure of unplanned pregnancy. J Epidemiol Community Health. 2004;58(5):426–33.CrossRef
23.
go back to reference O'Connor A. User manual -- decisional conflict scale (16 item statement format). Ottawa: hospital research institute; 1993. O'Connor A. User manual -- decisional conflict scale (16 item statement format). Ottawa: hospital research institute; 1993.
24.
go back to reference Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory care quality improvement project (ACQUIP). Alcohol Use Disorders Identification Test. Arch Intern Med. 1998;158(16):1789–95.CrossRef Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory care quality improvement project (ACQUIP). Alcohol Use Disorders Identification Test. Arch Intern Med. 1998;158(16):1789–95.CrossRef
25.
go back to reference Finer LB, Kost K. Unintended pregnancy rates at the state level. Perspect Sex Reprod Health. 2011;43(2):78–87.CrossRef Finer LB, Kost K. Unintended pregnancy rates at the state level. Perspect Sex Reprod Health. 2011;43(2):78–87.CrossRef
26.
go back to reference Correction and Republication. Abortion surveillance - United States, 2014. MMWR Morb Mortal Wkly Rep. 2018;67(46):1302.CrossRef Correction and Republication. Abortion surveillance - United States, 2014. MMWR Morb Mortal Wkly Rep. 2018;67(46):1302.CrossRef
29.
go back to reference Roberts SCM, Turok DK, Belusa E, Combellick S, Upadhyay UD. Utah’s 72-hour waiting period for abortion: experiences among a clinic-based sample of women. Perspect Sex Reprod Health. 2016;48(4):179–87.CrossRef Roberts SCM, Turok DK, Belusa E, Combellick S, Upadhyay UD. Utah’s 72-hour waiting period for abortion: experiences among a clinic-based sample of women. Perspect Sex Reprod Health. 2016;48(4):179–87.CrossRef
30.
go back to reference Upadhyay UD, Kimport K, Belusa EKO, Johns NE, Laube DW, Roberts SCM. Evaluating the impact of a mandatory pre-abortion ultrasound viewing law: a mixed methods study. PLoS One. 2017;12(7):e0178871.CrossRef Upadhyay UD, Kimport K, Belusa EKO, Johns NE, Laube DW, Roberts SCM. Evaluating the impact of a mandatory pre-abortion ultrasound viewing law: a mixed methods study. PLoS One. 2017;12(7):e0178871.CrossRef
31.
go back to reference Roberts SCM, Foster DG, Gould H, Biggs MA. Changes in alcohol, tobacco, and other drug use over five years after receiving versus being denied a pregnancy termination. J Stud Alcohol Drugs. 2018;79(2):293–301.CrossRef Roberts SCM, Foster DG, Gould H, Biggs MA. Changes in alcohol, tobacco, and other drug use over five years after receiving versus being denied a pregnancy termination. J Stud Alcohol Drugs. 2018;79(2):293–301.CrossRef
32.
go back to reference Osterman MJK, Martin JA: Timing and Adequacy of Prenatal Care in the United States, 2016. National Vital Statistics Reports. vol. 67. Hyattsville, MD: National Center for Health Statistics; 2018. Osterman MJK, Martin JA: Timing and Adequacy of Prenatal Care in the United States, 2016. National Vital Statistics Reports. vol. 67. Hyattsville, MD: National Center for Health Statistics; 2018.
33.
go back to reference Macleod J, Hickman M, Smith GD. Reporting bias and self-reported drug use. Addiction. 2005;100(4):562–3.CrossRef Macleod J, Hickman M, Smith GD. Reporting bias and self-reported drug use. Addiction. 2005;100(4):562–3.CrossRef
34.
go back to reference Roberts SC, Pies C. Complex calculations: how drug use during pregnancy becomes a barrier to prenatal care. Mat Child Health J. 2011;15(3):333–41.CrossRef Roberts SC, Pies C. Complex calculations: how drug use during pregnancy becomes a barrier to prenatal care. Mat Child Health J. 2011;15(3):333–41.CrossRef
Metadata
Title
Estimating the proportion of Medicaid-eligible pregnant women in Louisiana who do not get abortions when Medicaid does not cover abortion
Authors
Sarah C. M. Roberts
Nicole E. Johns
Valerie Williams
Erin Wingo
Ushma D. Upadhyay
Publication date
01-12-2019
Publisher
BioMed Central
Keyword
Prenatal Care
Published in
BMC Women's Health / Issue 1/2019
Electronic ISSN: 1472-6874
DOI
https://doi.org/10.1186/s12905-019-0775-5

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