key: cord-0816906-eu0vjezp authors: Swartz, Jonas J.; Rowe, Carly; Morse, Jessica E.; Bryant, Amy G.; Stuart, Gretchen S. title: Women's knowledge of their state's abortion regulations. A national survey date: 2020-08-06 journal: Contraception DOI: 10.1016/j.contraception.2020.08.001 sha: 97f2a72c91a2a8f461faf08fe24a1e7af8c8a395 doc_id: 816906 cord_uid: eu0vjezp OBJECTIVES: States vary significantly in their regulation of abortion. Misinformation about abortion is pervasive and propagated by state-mandated scripts that contain abortion myths. We sought to investigate women’s knowledge of abortion laws in their state. Our secondary objective was to describe women’s ability to discern myths about abortion from facts about abortion. STUDY DESIGN: This was a cross-sectional study of English- and Spanish-speaking women aged 18-49 in the United States. We enrolled members of the GfK KnowledgePanel, a probability-based, nationally-representative online sample. Our primary outcome was the proportion of correct answers to 12 questions about laws regulating abortion in a respondent’s state. We asked five questions about common abortion myths. We used descriptive statistics to characterize performance on these measures and bivariate and multivariate modeling to identify risk factors for poor knowledge of state abortion laws. RESULTS: Of 2223 women contacted, 1057 (48%) completed the survey. The mean proportion of correct answers to 12 law questions was 18% (95% CI 17-20%). For three of five assessed myths, women endorsed myths about abortion over facts. Those who believe abortion should be illegal (aOR 2.18, CI 1.40-3.37), and those living in states with neutral or hostile state policies toward abortion (neutral aOR 1.99, CI 1.34-2.97; hostile aOR 1.6, CI 1.07-2.36) were at increased odds of poor law knowledge. CONCLUSIONS: Women had low levels of knowledge about state abortion laws and commonly endorse abortion myths. Women’s knowledge of their state’s abortion laws was associated with personal views about abortion and their state policy environment. IMPLICATIONS: Supporters of reproductive rights can use these results to show policy makers that their constituents are unlikely to know about laws being passed that may profoundly affect them. These findings underscore the potential benefit in correcting widely-held, medically-inaccurate beliefs about abortion so opinions about laws can be based on fact. reproductive rights 48 Implications: Supporters of reproductive rights can use these results to show policy makers that 49 their constituents are unlikely to know about laws being passed that may profoundly affect them. 50 These findings underscore the potential benefit in correcting widely-held, medically-inaccurate 51 beliefs about abortion so opinions about laws can be based on fact. Abortion is extremely safe and effective and high quality care is hindered rather than enhanced 54 by state-level barriers. [ of laws related to abortion among low-income immigrants (aged We designed a 41-item survey for our study (Figure 1 and Appendix 1) . We included items The 12 items written to collect data about abortion law knowledge were adapted from survey 114 questions used in prior studies. [11, 12] The items were designed to specifically ask how abortion 115 laws might affect the general public. We did not include survey questions about laws that 116 targeted abortion providers or facility requirements. Respondents were asked whether or not they 117 thought particular laws were in place in their state. For instance, a respondent from Nebraska 118 would be asked, "In Nebraska, is there a law that married women have to have their husband's 119 consent before an abortion?". Possible answers included "yes," "no", and "not sure." 135 We included one item to measure women's personal views on abortion. [10, 19] We asked the 136 question: "Which of the following statements about the issue of abortion comes closest to your 137 own view?" Response options were: "I believe having an abortion is morally acceptable and 138 should be legal;" "I am personally against abortion for myself, but I don't believe government 139 should prevent a woman from making that decision for herself;" "I believe having an abortion is 140 morally wrong and should be illegal." 141 We asked women whether they had been pregnant and among those with a pregnancy history, 143 whether they ever had an abortion. We also asked whether they had accompanied someone else 144 to obtain an abortion. Our primary outcome was the "knowledge sum score". The lowest possible score was zero, 177 when a respondent got none of the 12 knowledge questions correct. The highest possible score 178 was a 12, when a respondent got all 12 questions. The score is the proportion of laws that 179 respondents could correctly identify for their state. For each of the 12 knowledge questions, the 180 answer was scored zero for an incorrect response or not sure, and one for a correct answer. All 181 respondents had the same potential maximum score based on the laws in their state. Our secondary outcome was a score based on women's ability to correctly discern common 184 myths about abortion from true statements. This score was a sum of true statements about 185 abortion that respondents could identify. For example, respondents had to choose which of the 186 following statements is closer to the truth: "Abortion is safer than childbirth," or "Childbirth is 187 safer than abortion." In that example, the respondent would receive one point for the correct 188 statement that "abortion is safer than childbirth."[22] She would receive zero points for the myth 189 statement "Childbirth is safer than abortion" or "Don't know/Not sure." We created a sum score 190 for the five items. We performed a one-proportion Wald tests to test whether respondents were 191 more likely to get answers correct or incorrect. (Table 1) , well-educated and few came from households living below 100% of FPL. Women were diverse racially and ethnically. The majority had been pregnant in the past 224 (617/1032; 59%), and a notably small minority reported a history of abortion (107/1032; 10%). The majority of respondents completed the survey in English. Most women believed that the government should not make abortion illegal (570/1041; 73%). abortion, the most frequent answer was "don't know/not sure" (Figure 4 and Table A1 ). On 277 three of the five statements, respondents were more likely to endorse myths than true statements. 278 Respondents incorrectly reported that abortion causes depression and anxiety (incorrect 50% CI 279 47%-53%, correct 9% CI 7%-11%, p<0.001) [1, 24] In this nationally-representative assessment of reproductive-aged women's knowledge of their 286 state abortion laws, we found that few women had accurate impressions of the safety of abortion 287 and related laws. Previous regional studies have presented similar findings. [10, 14] . Surprisingly, 288 we did not find poverty, low levels of education, or low health literacy to be associated with 289 knowledge of state abortion laws. We also found that women were more likely than not to 290 endorse abortion myths. This may indicate either that this sample is not typical of the US population or social-desirability 315 bias in responses. The response rate was somewhat lower than for other GfK studies. KnowledgePanel members are not informed about the content of the survey when they decide 317 whether or not to follow the initial email link. Given the high participation rate among those who 318 opened the survey, we suspect high social-desirability bias regarding self-reporting abortion. Few women in our study had low health literacy, which is expected from KnowledgePanel Women were asked which was more likely to be true between an accurate statement (shown on 453 the right) and common abortion myth (shown on the left). individual abortion laws were enacted in the woman's state of residence. Table 2 provides additional 463 detail. Correct answers received one point. 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