Abortion does not change women’s self-esteem or well-being

The idea that abortion is emotionally traumatic for women has gained traction in recent years, and the notion that the procedure lowers self-esteem has spurred legislation that increasingly restricts abortion access. Data on whether abortion is related to self-esteem and life satisfaction are limited and mostly come from retrospective studies.

To fill this gap, researchers with the UCSF Bixby Center examined the effects of obtaining an abortion versus being denied an abortion on self-esteem and life satisfaction in the Turnaway Study. Using data from more than 900 women who sought an abortion from 30 facilities across the United States, the researchers found that: 

  • Women denied an abortion initially reported lower self-esteem and life satisfaction than women who sought and obtained an abortion. 
  • Women who obtained first-trimester abortions reported higher levels of life satisfaction, which remained steady over time, compared with other women. 
  • The initially lower levels of self-esteem and life satisfaction among women denied an abortion eventually improved, reaching similar levels as those obtaining abortions after six months to one year. 
  • Self-esteem and life satisfaction improved over time for all women, except those who received a first-trimester abortion since their levels were higher to begin with and remained steady.

While an abortion may be an emotionally significant event in a woman's life, there is no evidence that it causes harm to self-esteem or life satisfaction in the short or long term. In fact, these findings suggest that being denied an abortion is more harmful to women's feelings of self-worth and well-being in the short term. Other factors associated with low self-esteem are also related to having an abortion, such as having an unintended pregnancy or life circumstances that lead women to decide to terminate the pregnancy. Efforts to support women’s emotional well-being should focus on these and other factors known to impact self-esteem and life satisfaction.


Bixby program celebrates 20 years of research in Zimbabwe

This year marks the 20th anniversary of the Bixby Center's partnership with the University of Zimbabwe (UZ) in HIV/AIDS research. The collaborative research program has released a new report and website to commemorate this anniversary and highlight some of its noteworthy findings and accomplishments.

Since its launch in 1994, UZ-UCSF studies have helped shape national and global responses to the HIV/AIDS pandemic, and defined policies and standards regarding HIV acquisition, prevention, treatment and care. Examples include: 

  • Groundbreaking research in antiretroviral therapy (ART) for HIV prevention, including ART in patients co-infected with tuberculosis.
  • ART for prevention for couples with one HIV-positive and one HIV-negative partner.
  • Initiation and monitoring of pediatric ART. 
  • Microbicides for HIV prevention.
  • Community HIV testing strategies.
  • Prevention of mother-to-child HIV transmission.

Over the past 20 years, UZ-UCSF researchers have led 63 research studies with more than 15,000 participants. Additionally, the program has mentored the next generation of Zimbabwean and global researchers, supporting more than 200 upper-level students and postgraduates to date. The partnership is leading 22 ongoing studies, continuing to develop capacity to identify and respond to emerging scientific priorities.


Women pay significant out-of-pocket costs for abortion care

Under the Affordable Care Act, millions of women in the United States will have increased access to public and private health insurance. However, any potential gains in women’s access to health insurance will be limited by federal and state restrictions on coverage for abortion care. Even though an estimated 30% of U.S. women will have an abortion by age 45, longstanding restrictions limit the use of federal Medicaid funds for the procedure, and new restrictions limit private insurance coverage for abortion care.

New research from the UCSF Bixby Center reveals that due to these restrictions, many women pay substantial out-of-pocket costs for abortion care. Based on interviews with women visiting 30 abortion clinics nationwide, the researchers found that:

  • Twenty-nine percent paid the full cost out-of-pocket.
  • Two-thirds (71%) received some financial assistance in covering the cost of an abortion, mainly state Medicaid (34%) and other organizations (29%). 
  • Even with financial assistance, most women had some out-of- pocket costs for abortion. Out-of-pocket costs for abortion paid by the woman, family, or friends ranged from $0 to $3,700, with an average of $474. 
  • For more than half of the study participants, total out-of-pocket costs (including abortion and travel) were more than one-third of their monthly income. 
  • More than half of women (54%) reported that raising money for an abortion delayed obtaining care.

There are significant gaps in the system for providing financial assistance, insurance and Medicaid coverage for abortion care. New state-level laws further restricting insurance coverage for abortion will only exacerbate existing challenges. The researchers call for studies to examine how new restrictions on private insurance coverage for abortion burden women seeking safe reproductive health care.


Measuring women’s reproductive autonomy

Researchers are increasingly recognizing the importance of women’s reproductive autonomy for their health and well-being. Reproductive autonomy is having the power to decide and control contraceptive use, pregnancy, and childbearing. For example, women with reproductive autonomy can control whether and when to become pregnant, whether and when to use contraception, which method to use, and whether and when to continue a pregnancy.

Despite the importance of such decisions for women’s health, few studies have assessed reproductive autonomy using a validated measure or examined how autonomy affects contraceptive use. Researchers from the UCSF Bixby Center sought to address this issue by creating a validated instrument to measure women's reproductive autonomy. The measure:

  • Is applicable to women in any type of sexual relationship (married or unmarried, cohabitating or not) and to women living in a variety of gender-equity contexts worldwide. 
  • Captures the influence of other individuals in addition to women's sexual partners, such as parents, in-laws, and friends. 
  • Is concise, so that it could be easily inserted into standardized questionnaires, evaluations, or clinical assessments.

Researchers hope this tool will help addresses the significant void in studies of women's empowerment and health. Over time, the tool may show that sexual and reproductive health interventions that explicitly address women's reproductive autonomy are more effective at helping women realize their reproductive goals.


Over-the-counter access to oral contraceptives could help increase use

Unintended pregnancy is a significant public health issue in the United States, accounting for half of all pregnancies. One significant contributing factor is that many women have problems accessing contraceptives. Additionally, women who have abortions are at high risk for future unintended pregnancy, and are therefore an important population to include when examining barriers to contraceptive access.

Making oral contraceptive pills accessible over-the-counter (OTC) may improve the availability of this effective method. OTC access could also be attractive to women who have difficulty obtaining prescriptions, including some women seeking abortion. Researchers with the UCSF Bixby Center surveyed women seeking abortions across the United States to gauge their interest in obtaining the pill OTC.

The researchers found a high level of interest in OTC access: 

  • 81% of participants supported OTC access to oral contraceptives.
  • 42% planned to use the pill after their abortion. This increased to 61% if it were available OTC.
  • 33% who planned to use no contraceptive following abortion said they would use an OTC pill, as did 38% who planned to use condoms afterward.
  • Uninsured participants showed greater interest in OTC access than those with private insurance.

Oral contraceptive use among women at high risk of unintended pregnancy may increase if the pill were available without prescription. Women consider OTC access convenient and timesaving compared to clinic visits. The pill is already formally or informally available without a prescription in many countries.