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

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.

Complex situations: Economic insecurity, mental health, and substance use among pregnant women who consider – but do not have – abortions

“…We also aimed to: 1) Understand women's experiences considering and seeking abortions in a state with multiple versus few restrictive abortion policies; 2) Assess health & social service needs of women who consider but do not have abortions; and 3) Understand women's experience with and impacts of Pregnancy Resource Centers. We have previously published some findings related to each aim [5,8,[22][23][24]]. The analyses presented in this manuscript are a-priori components of the first aim.…”

“…The analyses presented in this manuscript are a-priori components of the first aim. We have previously published findings that quantify differences in considering abortion and reporting a policy-related barrier to abortion between women living in a state with multiple versus few restrictive abortion policies [5], and quantify the impact of the policy-related barrier to abortion-lack of Medicaid coverage of abortion-that was most commonly referenced by study participants [8]. Here, we extend previous findings by 1) using multivariable analysis to rigorously assess individual-level characteristics of those who consider but do not have abortions and those who report policy-related barriers to abortion and 2) bringing in the qualitative component of the study to explore the concrete ways policies become barriers to abortion care.…”

“…In this mixed-methods study, quantitative and qualitative data collections were convergent and embedded (Fig 1). Study methods have been described in detail previously [5,8,22,23]. Briefly, we recruited 589 English and Spanish-speaking pregnant women 18 years and older at their first prenatal care visit at three prenatal care facilities in Southern Louisiana and one prenatal care facility in Baltimore, Maryland between June 2015 and June 2017.…”

“…What these bans purport to accomplish-making abortion impossible to obtain in that state-is already happening in some states for some women [5,6]. There is a substantial and growing body of literature examining impacts of extant restrictive abortion policies and women's experiences of these policies Previous research indicates some restrictive abortion policies-such as gestational limits, laws requiring abortion providers to have hospital admitting privileges (and which can lead abortion clinics to close), lack of Medicaid funding to pay for low-income women's abortions, and multiple policies in combination-put abortion out of reach for some women [5][6][7][8][9]. There is also a robust body of research that documents adverse impacts on women and children when women are unable to obtain wanted abortions; these include: economic insecurity, adverse physical health impacts, ongoing violence from the man involved in the pregnancy, and adverse impacts on children's development and maternal bonding [10][11][12][13][14].…”

Health-related quality of life of hospitalized COVID-19 survivors: An initial exploration in Nanning city, China

“…Laws imposing gestational limits restrict patient eligibility for abortion and can prevent people from obtaining a wanted abortion or force them to seek care further away from home, delaying care and increasing costs ( Upadhyay et al, 2014 ). Bans on state Medicaid or private insurance coverage of abortion increase out of pocket costs, which makes abortion inaccessible to many ( Jones et al, 2013 ; Roberts et al, 2019 , 2014 ).…”