The Effects of Covid 19 Pandemic on Mental Health of the Individual Global Health

ABORTION RESTRICTIONS AND LIMITED MATERNAL HEALTH SERVICES 8

*** This sample was adapted from a Monroe College student’s final paper. ***

Discussion

Introduction to Discussion

Women’s reproductive health is in jeopardy specifically in relation to restrictions to

abortion and prenatal health services. These limitations continue to be an expanding issue for

pregnant and adolescent women, ultimately resulting in life long physical, emotional, and mental

health implications for both mothers and their children (Janighorban et al., 2021). Studies

(Janighorban et al., 2021; Pabayo et al., 2020) have shown there are implications for the children

born in areas with restrictive laws and limitations to sexual reproductive health services and

education, such as an increased risk of infant morbidity and mortality. The long-term impacts on

children in areas where abortion is completely banned impedes on socioeconomic status long-

term or indefinitely, and children born to teen and adolescent mothers were more likely to be

teen parents and less likely to seek higher education (Hajdu et al., 2021). Besides the bestowed

children under these conditions, the pregnant women giving birth have also been seen to have

lifelong implications such as physical health issues, defective life skills, mental health issues, and

behavioral issues (Hajdu et al., 2022).

Evidence-Based Recommendations

Recommendations from Literature Review

Access to maternal health care and prenatal services is vital component to successful

pregnancies and reducing mortality and morbidity for both the children and mothers (Carlson &

Neuberger, 2021). With new limitations on abortion, reducing teen pregnancy is imperative.

Future studies are needed to measure the impact of these restrictions (Pabayo et al., 2020), if

unwanted pregnancies are going to be inevitable, and leaders need to strengthen the current

ABORTION RESTRICTIONS AND LIMITED MATERNAL HEALTH SERVICES 9

*** This sample was adapted from a Monroe College student’s final paper. ***

systems in place. De Londras et al. (2022) recommended use of the WHO’s international

guidelines be enforced to maximize health outcomes, health system efficiency, and to ensure

human rights, while Hajdu and Hajdu (2021) focused on the consequences of access to abortion

and family planning and urged the importance of implementing abortion policies. Their results

(Hajdu & Hajdu, 2021) could be utilized in creating such policies. Like Hajdu and Hajdu (2021),

Janighorban et al. (2022) recommended developing comprehensive and practical programs

beyond legal and political purviews. They (Janighorban et al., 2022) argued the repercussions of

limited access to family planning and abortion could impact the health of adolescents in varying

societies.

Program Recommendation

As research (Hajdu & Hajdu, 2021; Janighorban et al., 2022) has suggested the

importance of future studies and creation of policies to protect access to family planning, one

existing program that could be expanded is Women, Infant, and Children (WIC), a program

instated in order to mitigate the discrepancies in access to nutritional care (FNS, 2013). This was

brought forth by the Food and Nutrition Services (FNS), an agency within the United State

Department of Agriculture (USDA). They implemented a nutrition assistance program for

pregnant women and mothers, infants up to six months, and children under the age of five. The

WIC program was designed for this population who are of low-income status; guidelines deem

this to be between 100-185% of the federal poverty line for eligibility, those experiencing

nutritional risk such as malnourishment, underweight, diabetes, high risk pregnancy, in addition

to others (FNS, 2013). This program provides supplemental nutrition, nutrition education,

breastfeeding support and referrals to prenatal and other health services.

ABORTION RESTRICTIONS AND LIMITED MATERNAL HEALTH SERVICES 10

*** This sample was adapted from a Monroe College student’s final paper. ***

Benefits of this programs has been linked to decreased infant morbidity and mortality

among women and infants (Carlson & Neuberger, 2021). WIC has been associated with longer

gestational periods, and higher birth weights (FNS, 2013). Children under two have been

documented to have improved rates of immunization and regular access to medical care within

the first year of life and associated with a higher likelihood of having a regular provider

throughout childhood (Carlson & Neuberger, 2021). Access to these services is also linked with

lower healthcare costs to mothers and families, making maternal health services more accessible

(FNS, 2013).

The present research recommends that WIC should be expanded to incorporate sex-

education. Only 21 states mandate lessons on contraception. The majority of the country teaches

only abstinence (Disi et al., 2022). If WIC were to expand access to more of the population by

providing in-depth sex education and more government funding, then public health professionals

could aid in significantly reducing the risks of pregnancy for both mother and child. If this

program were to expand to all women in need of contraception, sex education, prenatal care,

maternal healthcare services, access to these benefits would reduce risks associated with

pregnancy, as well as reduction of risks of teen pregnancy.

The Conclusion would go here,

introduced by a Level 1 Header and adhering to APA 7 Basics

– No page breaks between sections or extra spaces

ABORTION RESTRICTIONS AND LIMITED MATERNAL HEALTH SERVICES 1

The Impacts of Abortion Restrictions and Limited Maternal Health Services

Alyssa Strickland

Department of Public Health, Monroe College, King Graduate School

KG 604: Graduate Research & Critical Analysis

Professor Amanda Ramlochan

March 26, 2023

*** This sample was adapted from a Monroe College student’s final paper. ***

ABORTION RESTRICTIONS AND LIMITED MATERNAL HEALTH SERVICES 2

The Impacts of Abortion Restrictions and Limited Maternal Health Services

Introduction

Access to maternal health services is a fundamental component to achieving health

equity; it is estimated by the United Nations (2022) that 121 million pregnancies each year are

unintended, with 45% of all abortions deemed unsafe, causing 810 women to die each day, due

to preventable causes related to childbirth. Appropriate measures to ensure safe and reliable

maternal health services before and after birth is imperative and should be a fundamental right

for all women. An expansion of resources, increased funding, proper education on contraception,

and access to maternal and prenatal care is needed to ensure safety for all women and create a

sense of bodily autonomy (Carlson & Neuberger, 2021; Disi et al., 2022).

Literature Review

Introduction to Literature Review

Safe and available access to maternal health services while abortion restrictions and

stigmatization continues to pose issues for young pregnant women (Janighorban et al., 2022).

With abortion restrictions on the rise and limited access to providers, it is imperative to assess the

risk factors that this imposes on pregnant women and women’s reproductive rights. The literature

review included only peer-reviewed, research articles and literature regarding the factors of

limited access to sexual reproductive services and prenatal care for women long-term. Some of

these factors include socioeconomic status, defective life skills, and mental health issues were

analyzed. The databases used to conduct the literature review was ProQuest and Medline from

the Monroe College library. Keywords and phrases included in the search for the articles

ABORTION RESTRICTIONS AND LIMITED MATERNAL HEALTH SERVICES 3

documented in the literature review reflect the following: abortion, abortion access, impacts of

abortion restriction, and maternal health service limitations.

Review of Literature

Limited Access of Care

Janighorban et al. (2021) conducted a mixed-methods research study using semi-

structured interviews in order to explore the impediments to access when it concerns

reproductive and sexual health services. This study was conducting using 120 female participants

ages 14-19, and 22 key informants that worked as midwives, psychologists or social workers in

April 2019 to June 2020 in Iran, specifically Isfahan, Tehran and Mashhad. Through in-depth

semi-structured interviews, the study participants explained in depth their experiences of barriers

to sexual and reproductive/maternal health services among teenage girls. They found that the

ineffectiveness of key organizations in providing sexual and reproductive health services as well

as lacking in political, legal, and social support indicate that the sexual and reproductive health

of these girls is not a priority for Iranian society. They were able to conclude in their research

that the long-term effects of the severe limitations to sexual health services, specifically when it

concerns abortions and prenatal services in this age group, were family challenges, easily

succumbing to peer pressure, inability to make informed decisions when it pertains to sex, and

lack of knowledge in relation to sexual health threats, and psychological distress (Janighorban et

al., 2021).

Hadju et al. (2022) conducted secondary, quantitative research analysis in order to

identify the long-term consequences of restrictive access to abortion, specifically following the

change in abortions laws after 1974 in Hungary. The study was conducted through a secondary,

ABORTION RESTRICTIONS AND LIMITED MATERNAL HEALTH SERVICES 4

quantitative research methodology, using the 2011 census in Hungary. They were able to

conclude from their research that children born after the law change to women under the age of

35 were less likely to seek higher education. They also found that these children were also far

more likely to become teen parents themselves. The restrictive abortion policy in Hungary

ultimately resulted in negative impacts on the socioeconomic results in the lives of the children

born after the law was put in place. As a whole, they saw that children born after the law change

had worse educational outcomes, and the law change overall reflect an unwantedness effect

(Hadju et al., 2022).

Changing Stigma and Expansion of Research

Maxwell et al. (2021) conducted a qualitative research analysis in October of 2019.

Unlike the previous studies (Hadju et al., 2022; Janighorban et al., 2021), Maxwell et al. (2021)

conducted this research study in order to figure out how providers can help normalize abortion,

challenge the stigma, and challenge sociocultural narrative surrounding the topic. Everyday

discussion as it pertains to abortion is generally negative, instilling shame and distress around the

topic and discussion, even though it is a common gynecological procedure. They conducted the

research study using a qualitative research approach, and conducted 20 interviews using thematic

analysis. From their research, they were able to identify four interconnecting themes among the

providers interviewed: 1. Resistance to abortion from their colleagues 2. negative sociocultural

abortion accounts. 3. Aims to achieve positivity or neutrality around abortion procedures. 4.

presenting abortion as normal and a part of maternal, sexual, and gynecological healthcare.

Further, they explained that abortion should not be considered wrong or viewed as inherently

negative, and it can be presented as a routine component of sexual and reproductive healthcare.

ABORTION RESTRICTIONS AND LIMITED MATERNAL HEALTH SERVICES 5

Presenting abortion neutral and positive ways can help limit and resist negative framings of the

procedure (Maxwell et al., 2021).

Lastly, Pabayo et al. (2022) carried out a secondary, quantitative research analysis in

order to determine if there was a connection between infant mortality risk and limited abortion

services in the states with varying restrictions among abortion laws in different states in the

United States. The data used for this studied came from infants born from 2008-2010 and used

this data comparatively to infants born in different regions of the world in 2015 and 2017. The

data was collected in the United States, at varying academic institutes including University of

Alberta, located in Alabama, University of Nevada, University of Utah, Columbia University,

and Montclair State University. They looked for a causal relationship between restrictive

abortion laws and infant mortality, and pulled direct statistics and numbers from LBID and

NCHS in accordance, and assessed specific laws and drew their research from there. They were

able to conclude that Infants born to Black mothers, single mothers, and low-income mothers

have higher infant mortality rates compared to infants born to White mothers, married mothers,

and moderate/high-income mothers. They were unable to find a definitive causal relationship,

but when they tested the relationship between infant mortality and five different abortion

restrictive laws they chose, they were able to determine that there is an increase in risk of infant

mortality when the laws are more restrictive.

Analysis of Literature

Maxwell et al. Hajdu et al. (2021), Janighorban et. al (2022) and Pabayo et al. (2020) all

used qualitative research as component of the methodology used when conducting their research.

All four studies indicate that there are negative impacts on health outcomes and demonstrate a

violation to human and women’s reproductive rights when it comes to abortion access and

ABORTION RESTRICTIONS AND LIMITED MATERNAL HEALTH SERVICES 6

restrictive abortion laws. The more restrictive abortion laws overly complicate the provider-

patient relationships. They have been able to conclude that this specifically effects younger

women when it comes to reproductive health and shows negative impacts in the long run,

specifically to socioeconomic status, family planning, mental health implications, and fear and

avoidance associated with current healthcare systems. Comparatively, in Pabayo et al. (2020),

their research focuses more heavily on the risks of mortality among infants when abortions laws

are more restrictive, while Hadju et al. (2021) and Janighorban et al. (2022) focus more on the

implications to young mothers and their social and economic status following the inhibitions of

abortion access as opposed to discussing the morality implications are discussed in the former.

Meanwhile, Maxwell et al (2021) discuss the overall impacts to the healthcare system, and being

able to access a quality provider that has been trained and 1. Allowed to perform specific

procedures and 2. Properly trained to do so.

Discussion

Introduction to Discussion

Women’s reproductive health is in jeopardy specifically in relation to restrictions to

abortion and prenatal health services. These limitations continue to be an expanding issue for

pregnant and adolescent women, ultimately resulting in life long physical, emotional, and mental

health implications for both mothers and their children (Janighorban et al., 2021). Studies

(Janighorban et al., 2021; Pabayo et al., 2020) have shown there are implications for the children

born in areas with restrictive laws and limitations to sexual reproductive health services and

education, such as an increased risk of infant morbidity and mortality. The long-term impacts on

children in areas where abortion is completely banned impedes on socioeconomic status long-

term or indefinitely, and children born to teen and adolescent mothers were more likely to be

ABORTION RESTRICTIONS AND LIMITED MATERNAL HEALTH SERVICES 7

teen parents and less likely to seek higher education (Hajdu et al., 2021). Besides the bestowed

children under these conditions, the pregnant women giving birth have also been seen to have

lifelong implications such as physical health issues, defective life skills, mental health issues, and

behavioral issues (Hajdu et al., 2022).

Evidence-Based Recommendations

Recommendations from Literature Review

Access to maternal health care and prenatal services is vital component to successful

pregnancies and reducing mortality and morbidity for both the children and mothers (Carlson &

Neuberger, 2021). With new limitations on abortion, reducing teen pregnancy is imperative.

Future studies are needed to measure the impact of these restrictions (Pabayo et al., 2020), if

unwanted pregnancies are going to be inevitable, and leaders need to strengthen the current

systems in place. De Londras et al. (2022) recommended use of the WHO’s international

guidelines be enforced to maximize health outcomes, health system efficiency, and to ensure

human rights, while Hajdu and Hajdu (2021) focused on the consequences of access to abortion

and family planning and urged the importance of implementing abortion policies. Their results

(Hajdu & Hajdu, 2021) could be utilized in creating such policies. Like Hajdu and Hajdu (2021),

Janighorban et al. (2022) recommended developing comprehensive and practical programs

beyond legal and political purviews. They (Janighorban et al., 2022) argued the repercussions of

limited access to family planning and abortion could impact the health of adolescents in varying

societies.

Program Recommendation

ABORTION RESTRICTIONS AND LIMITED MATERNAL HEALTH SERVICES 8

As research (Hajdu & Hajdu, 2021; Janighorban et al., 2022) has suggested the

importance of future studies and creation of policies to protect access to family planning, one

existing program that could be expanded is Women, Infant, and Children (WIC), a program

instated in order to mitigate the discrepancies in access to nutritional care (FNS, 2013). This was

brought forth by the Food and Nutrition Services (FNS), an agency within the United State

Department of Agriculture (USDA). They implemented a nutrition assistance program for

pregnant women and mothers, infants up to six months, and children under the age of five. The

WIC program was designed for this population who are of low-income status; guidelines deem

this to be between 100-185% of the federal poverty line for eligibility, those experiencing

nutritional risk such as malnourishment, underweight, diabetes, high risk pregnancy, in addition

to others (FNS, 2013). This program provides supplemental nutrition, nutrition education,

breastfeeding support and referrals to prenatal and other health services.

Benefits of this programs has been linked to decreased infant morbidity and mortality

among women and infants (Carlson & Neuberger, 2021). WIC has been associated with longer

gestational periods, and higher birth weights (FNS, 2013). Children under two have been

documented to have improved rates of immunization and regular access to medical care within

the first year of life and associated with a higher likelihood of having a regular provider

throughout childhood (Carlson and Neuberger, 2021). Access to these services is also linked with

lower healthcare costs to mothers and families, making maternal health services more accessible

(FNS, 2013).

The present research recommends that WIC should be expanded to incorporate sex-

education. Only 21 states mandate lessons on contraception. The majority of the country teaches

only abstinence (Disi et al., 2022). If WIC were to expand access to more of the population by

ABORTION RESTRICTIONS AND LIMITED MATERNAL HEALTH SERVICES 9

providing in-depth sex education and more government funding, then public health professionals

could aid in significantly reducing the risks of pregnancy for both mother and child. If this

program were to expand to all women in need of contraception, sex education, prenatal care,

maternal healthcare services, access to these benefits would reduce risks associated with

pregnancy, as well as reduction of risks of teen pregnancy.

Conclusion

It is important to ensure that each person has access to health care resources especially

when the goal is health equity for all. These pre-existing inequities in reproductive healthcare

services are evident in our current healthcare system, and a greater, more targeted public health

response is needed to make meaningful change and foster positive outcomes for all women, girls

and children. Therefore, fostering other ways to cultivate change and provide easy access to

prenatal care, maternal healthcare services, and execute the right to bodily autonomy is of the

utmost importance.

ABORTION RESTRICTIONS AND LIMITED MATERNAL HEALTH SERVICES 10

References

Carlson, S. & Neuberger, Z. (2021, January 27). WIC Works: Addressing the nutrition and health

needs of low-income families for more than four decades. Center on Budget and Policy

Priorities. https://www.cbpp.org/research/food-assistance/wic-works-addressing-the-

nutrition-and-health-needs-of-low-income-

families#:~:text=Seminal%20USDA%20research%20early%20in,infants%2C%20and%2

0fewer%20infant%20deaths.

Food and Nutrition Services. (2013, October). About WIC: How WIC helps. U.S. Department of

Agriculture, Food and Nutrition Services. https://www.fns.usda.gov/wic/about-wic-how-

wic-helps

Hajdu, G., & Hajdu, T. (2021). The long-term impact of restricted access to abortion on

children’s socioeconomic outcomes. PLoS One, 16(3).

https://doi.org/10.1371/journal.pone.0248638

Janighorban, M., Boroumandfar, Z., Pourkazemi, R., & Mostafavi, F. (2022). Barriers to

vulnerable adolescent girls’ access to sexual and reproductive health. BMC Public

Health, 22, 1-16. https://doi.org/10.1186/s12889-022-14687-4

Maxwell, K. J., Hoggart, L., Bloomer, F., Rowlands, S., & Purcell, C. (2021). Normalising

abortion: What role can health professionals play? BMJ Sexual & Reproductive

Health, 47(1), 32-36. https://doi.org/10.1136/bmjsrh-2019-200480

Pabayo, R., Ehntholt, A., Cook, D. M., Reynolds, M., Muennig, P., & Liu, S. Y. (2020). Laws

restricting access to abortion services and infant mortality risk in the United

ABORTION RESTRICTIONS AND LIMITED MATERNAL HEALTH SERVICES 11

States. International Journal of Environmental Research and Public Health, 17(11),

3773. https://doi.org/10.3390/ijerph17113773

*** This sample was adapted from a Monroe College student’s final paper. ***

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