Publications by authors named "Kathleen Broussard"

8 Publications

  • Page 1 of 1

Sibling loss and fertility desires in the high-mortality context of Peru.

Popul Stud (Camb) 2020 07 31;74(2):179-195. Epub 2020 Mar 31.

Population Research Centre, University of Texas, Austin.

Despite demographers' long-standing preoccupation with the effects of child mortality on women's fertility desires, scholars continue to know little about the consequences of other pervasive mortality exposures. We use nationally representative data from the high-mortality context of Peru to examine whether the desire to have a(nother) child varies as a function of sibling loss and to assess heterogeneity in this association by women's current number of children and a range of conditions related to siblings' deaths. Women who have experienced sibling bereavement and have two or more children report higher odds of desiring another child. These effects are not contingent on the age or sex of the deceased sibling but are only significant if the sibling died during the respondent's lifetime (not before). These findings highlight the theoretical and empirical import of investigating the relationship between fertility desires and a wider range of familial mortality exposures beyond own child mortality.
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http://dx.doi.org/10.1080/00324728.2020.1737188DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7282944PMC
July 2020

Knowledge, interest, and motivations surrounding self-managed medication abortion among patients at three Texas clinics.

Am J Obstet Gynecol 2020 08 3;223(2):238.e1-238.e10. Epub 2020 Mar 3.

Department of Statistics and Data Science, University of Texas at Austin, Austin, TX.

Background: A rapid increase in restrictive abortion legislation in the United States has sparked renewed interest in self-managed abortion as a response to clinic access barriers. Yet little is known about knowledge of, interest in, and experiences of self-managed medication abortion among patients who obtain abortion care in a clinic.

Objectives: We examined patients' knowledge of, interest in, and experience with self-managed medication abortion before presenting to the clinic. We characterized the clinic- and person-level factors associated with these measures. Finally, we examined the reasons why patients express an interest in or consider self-management before attending the clinic.

Materials And Methods: We surveyed 1502 abortion patients at 3 Texas clinics in McAllen, San Antonio, and Fort Worth. All individuals seeking abortion care who could complete the survey in English or Spanish were invited to participate in an anonymous survey conducted using iPads. The overall response rate was 90%. We examined the prevalence of 4 outcome variables, both overall and separately by site: (1) knowledge of self-managed medication abortion; (2) having considered self-managing using medications before attending the clinic; (3) interest in medication self-management as an alternative to accessing care at the clinic; and (4) having sought or tried any method of self-management before attending the clinic. We used binary logistic regression models to explore the clinic- and patient-level factors associated with these outcome variables. Finally, we analyzed the reasons reported by those who had considered medication self-management before attending the clinic, as well as the reasons reported by those who would be interested in medication self-management as an alternative to in-clinic care.

Results: Among all respondents, 30% knew about abortion medications available outside the clinic setting (37% in Fort Worth, 33% in McAllen, 19% in San Antonio, P < .001), and among those with prior knowledge, 28% had considered using this option before coming to the clinic (36% in McAllen, 25% in Fort Worth, 21% in San Antonio, P = .028). Among those without prior knowledge of self-management, 39% expressed interest in this option instead of coming to the clinic (54% in San Antonio, 30% in McAllen, 29% in Fort Worth, P < .001). Overall, 13% had sought out or tried any method of self-management before presenting to the clinic (16% in McAllen and 15% in Fort Worth vs 9% in San Antonio, P < .001). Experiencing barriers to clinic access was associated with having considered medication self-management (odds ratio, 2.2; 95% confidence interval, 1.7-3.0) and with seeking or trying any method of self-management before attending the clinic (odds ratio, 1.9; 95% confidence interval, 1.3-2.7). Difficulty affording the cost of in-clinic care was the most commonly cited reason for having considering medication self-management before attending the clinic. Reasons for interest in medication self-management as an alternative to clinic care included both access barriers and preferences for the privacy and comfort of home.

Conclusion: Considering or attempting self-managed abortion may be part of the pathway to seeking in-clinic care, particularly among those experiencing access barriers. However, considerable interest in medication self-management as an alternative to the clinic also suggests a demand for more autonomous abortion care options.
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http://dx.doi.org/10.1016/j.ajog.2020.02.026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7395859PMC
August 2020

The changing landscape of abortion care: Embodied experiences of structural stigma in the Republic of Ireland and Northern Ireland.

Soc Sci Med 2020 01 19;245:112686. Epub 2019 Nov 19.

Population Research Center, Department of Sociology, University of Texas at Austin, 305 E 23rd St, RLP 2.602, Austin, TX, 78712, USA. Electronic address:

The private use of abortion medication outside of the formal healthcare setting is an international phenomenon. Despite new and expanding pathways to abortion access, we know little about how women's perceptions and experiences of abortion may also be changing. This study examines the embodied experience of 68 women who sought abortion services in Northern Ireland and the Republic of Ireland. Social stigma and restrictive abortion laws were major barriers to care at the time of study, providing the opportunity to explore the ways biological, social, and structural factors shape embodiment. Those who obtained an abortion either traveled abroad for clinical care or self-managed a medication abortion at home. Participant's perceptions of pain, the fetus, the method (medication vs. surgical), and environment in which they sought abortion care (at home vs. in a clinic) were shaped by structural stigma. Women gained greater experiential knowledge through medication self-management, allowing them to relate abortion to other natural bodily processes and redefine their beliefs about pregnancy and the fetus. Preferences and attitudes about the environment of abortion care were informed by stigma and differential perceptions of risk. Those who traveled most often emphasized legal and medical risks of abortion at home, while those who self-managed emphasized social, financial, and emotional risks of pursuing clinical abortion care abroad. Given the increase in reproductive self-care alternatives, these findings situate self-managed abortion in the literature of (de)medicalization and reveal the ways technology and structural factors shape perceptions and beliefs about pain, the fetus, method, and environment. For some, self-managed medication abortion may be a preferred pathway to care. Policies that consider medication self-management as part of a spectrum of legitimate options can improve abortion access for marginalized groups while also offering an improved abortion experience for those who prefer medication abortion and an out-of-clinic environment.
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http://dx.doi.org/10.1016/j.socscimed.2019.112686DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6930969PMC
January 2020

Demand for Self-Managed Medication Abortion Through an Online Telemedicine Service in the United States.

Am J Public Health 2020 01 17;110(1):90-97. Epub 2019 Oct 17.

Abigail R. A. Aiken and Dana M. Johnson are with the LBJ School of Public Affairs, University of Texas, Austin. Jennifer E. Starling and James G. Scott are with the Department of Statistics and Data Sciences, University of Texas, Austin. Alexandra van der Wal and Sascha van der Vliet are with the Faculty of Science, VU University, Amsterdam. Kathleen Broussard is with the Department of Sociology, University of Texas, Austin. Elisa Padron is with the College of Natural Sciences, University of Texas, Austin. Rebecca Gomperts is with the Women on Web International Foundation, Amsterdam.

To examine demand for abortion medications through an online telemedicine service in the United States. We examined requests from US residents to the online telemedicine abortion service Women on Web (WoW) between October 15, 2017, and August 15, 2018. We calculated the population-adjusted rate of requests by state and examined the demographics, clinical characteristics, and motivations of those seeking services, comparing those in states with hostile versus supportive abortion policy climates. Over 10 months, WoW received 6022 requests from US residents; 76% from hostile states. Mississippi had the highest rate of requests (24.9 per 100 000 women of reproductive age). In both hostile and supportive states, a majority (60%) reported a combination of barriers to clinic access and preferences for self-management. Cost was the most common barrier (71% in hostile states; 63% in supportive states;  < .001). Privacy was the most common preference (49% in both hostile and supportive states;  = .66). Demand for self-managed medication abortion through online telemedicine is prevalent in the United States. There is a public health justification to make these abortions as safe, effective, and supported as possible.
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http://dx.doi.org/10.2105/AJPH.2019.305369DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6893344PMC
January 2020

Assessing public awareness and use of medical abortion via mobile phone survey in India

Contraception 2019 12 28;100(6):457-463. Epub 2019 Aug 28.

Population Research Center, University of Texas at Austin, 305 E 23rd St, RLP 2.602, Austin, TX 78712, United States. Electronic address:

Objective: We assess the feasibility of measuring awareness and use of medical abortion via a mobile phone survey on social attitudes in India.

Study Design: In 2018, we conducted a mobile phone survey with 3455 married men and women in Bihar and Maharashtra, two of India's most populous states. As part of a broader survey on social inequality, welfare programs, and health, we asked respondents about their awareness of medical abortion and whether they (or their wife) had ever had a medical abortion.

Results: Among men and women in Bihar and Maharashtra, one fifth to one third of respondents said that they had heard of medical abortion. In Bihar, men were more likely than women to report having heard of pills that can be used to end a pregnancy. Awareness of medical abortion was positively associated with education and with women's status within the household. Consistent with results from representative face-to-face surveys, reported use of abortion medications was low.

Conclusion: Our findings demonstrate that respondents are willing to answer abortion-related questions via mobile phone survey and reveal differences in reported awareness of medical abortion according to region, sex, education, and household status.

Implications: Inclusion of abortion-related questions in a large-scale, social attitudes phone survey is a feasible option for assessing public awareness of medical abortion in India.
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http://dx.doi.org/10.1016/j.contraception.2019.08.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6893080PMC
December 2019

The impact of Northern Ireland's abortion laws on women's abortion decision-making and experiences.

BMJ Sex Reprod Health 2018 Oct 19. Epub 2018 Oct 19.

LBJ School of Public Affairs, University of Texas at Austin, Austin, Texas, USA.

Background: In Northern Ireland, abortion is illegal except in very limited circumstances to preserve a woman's life or to prevent permanent or long-term injury to her physical or mental health. Abortions conducted outside the law are a criminal offence punishable by imprisonment. We assessed the impacts of Northern Ireland's abortion laws on women's decision-making and experiences in accessing abortion.

Methods: Between April 2017 and February 2018 we interviewed 30 women living in Northern Ireland who had sought abortion by travelling to a clinic in Great Britain or by using online telemedicine to self-manage a medication abortion at home. We interviewed women both before and after a policy change that allowed women from Northern Ireland access to free abortion services in Great Britain. We used a semi-structured in-depth approach and analysed the interviews using grounded theory methodology to identify key themes.

Results: Four key findings emerged from our analysis: (1) women experience multiple barriers to travelling for abortion services, even when abortion is provided without charge; (2) self-management is often preferred over travel, but its criminalisation engenders fear and isolation; (3) obstruction of import of abortion medications by Northern Ireland Customs contributes to stress, anxiety, a higher risk of complications, and trial of ineffective or unsafe methods; and (4) lack of clarity surrounding the obligations of healthcare professionals in Northern Ireland causes mistrust of the healthcare system.

Conclusions: Northern Ireland's abortion laws negatively affect the quality and safety of women's healthcare and can have serious implications for women's physical and emotional health. Our findings offer new perspectives for the current policy debate over Northern Ireland's abortion laws and suggest a public health rationale for decriminalising abortion.
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http://dx.doi.org/10.1136/bmjsrh-2018-200198DOI Listing
October 2018

Motivations and Experiences of People Seeking Medication Abortion Online in the United States.

Perspect Sex Reprod Health 2018 12 11;50(4):157-163. Epub 2018 Jul 11.

Undergraduate student, College of Natural Sciences, University of Texas at Austin.

Context: State legislation restricting access to abortion in the clinic setting raises the possibility that an increasing number of individuals in the United States will self-manage their abortion at home. Medications sourced online represent a potential pathway to abortion self-management. Yet, very little is known about the reasons U.S. residents may seek abortion online or their experiences finding medications and information.

Methods: In January-June 2017, anonymous in-depth interviews were conducted with 32 people from 20 states who sought abortion medications online (30 women and two men seeking medications for their partners). Participants were asked about their (or their partners') motivations for considering self-managed abortion, the sources of medications they identified and any other methods they considered. Transcripts were coded and analyzed according to the principles of grounded theory.

Results: The analysis revealed four key themes: Seeking abortion medications online can be a response to clinic access barriers both in states with and in ones without restrictive abortion laws; self-managed abortion can be a preference over clinical care; online options offer either information or medications, but not both; and the lack of trusted online options can delay care and lead to consideration of ineffective or unsafe alternatives.

Conclusion: Current online options for abortion medications leave many important needs unmet, particularly for women who encounter barriers to obtaining clinic-based abortion services. There is a public health justification to reduce clinic access barriers and to make medication abortion that is sourced online and managed at home as safe and supported as possible.
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http://dx.doi.org/10.1363/psrh.12073DOI Listing
December 2018

Experiences of women in Ireland who accessed abortion by travelling abroad or by using abortion medication at home: a qualitative study.

BMJ Sex Reprod Health 2018 May 15. Epub 2018 May 15.

College of Natural Sciences, University of Texas at Austin, Austin, Texas, USA.

Background: The Republic of Ireland has one of the world's most restrictive abortion laws, allowing abortion only to preserve a pregnant woman's life. We examined the impact of the law on women's options for accessing abortion, their decision-making regarding whichpathway to follow, and their experiences with their chosen approach.

Methods: We conducted semi-structured in-depth interviews with 38 women who had either travelled abroad to access abortion in a clinic or had self-managed a medical abortion at home using online telemedicine, between 2010 and 2017. We coded interview transcripts according to an iteratively developed coding guide and performed a thematic analysis to identify key themes.

Results: We identified four key themes: (1) self-managing a medical abortion at home using online telemedicine can be a preference over travelling abroad to access abortion services; (2) regardless of the pathway chosen, women experience a lack of pre- and post-abortion support in the Irish healthcare system; (3) feelings of desperation while searching for safe abortion care can lead to considering or attempting dangerous methods; and (4) Irish abortion law and attitudes have impacts beyond physical health considerations, engendering shame and stigma.

Conclusions: Despite the country's restrictive abortion law, women in Ireland do obtain abortions, using methods that are legal and safe elsewhere. However, the law negatively impacts women's ability to discuss their options with their healthcare professionals and to seek follow-up care, and can have serious implications for their physical and emotional health. This study's findings provide evidence to inform public and policy discourse on Ireland's abortion laws.
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http://dx.doi.org/10.1136/bmjsrh-2018-200113DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6237647PMC
May 2018