Public Health Problem Identification
Problem Description
Today, the healthcare system of the United States has to deal with numerous concerns and find solutions to diverse problems that concern millions of people. Family planning and reproductive health are two fields in which the U.S. government has developed certain policies and laws in order to shape the scope of governmental and social activities, determine organizational funding, and set requirements for people to follow (The Henry J. Kaiser family foundation, 2016). Reproductive health includes many issues for consideration, and abortion and post-abortion challenges are some of the most crucial. Post-abortion care is a significant public health problem that people should address and discuss from a variety of perspectives; it is a problem that touches upon numerous legal and regulatory restrictions as well as treatment-related, ethical, and moral concerns. Policies regarding abortion and post-abortion care have the ability to considerably change human lives, and as a result, they should provide the most appropriate methods of treatment and care.
Target Population
One notable feature of the abortion issue is its connection to a target population that includes not only women but also their families. Post-abortion care covers a number of aspects, including the psychological problems of women and their families; the importance of surviving the outcomes and finding reasons to continue routine social, family, and personal obligations; and the necessity to gain control over their own emotional challenges and financial needs. Post-abortion care should not only touch upon the women who have experienced this procedure. It should involve all potential mothers as well as fathers who are concerned about the outcomes of abortion and their male roles in society.
Existing Literature on the Problem
The debate surrounding abortion is currently heated in the United States. More than 950,000 abortions legally occurred in 2014, and it is difficult to determine the number of illegal abortions that take place annually (Abort73, 2016). Moreover, the World Health Organization has raised the question about the safety of abortion and related health outcomes, noting that more than 22 million unsafe abortions occur annually around the world (World health organization, 2015). Almost 70% of women admit that they are in need of appropriate post-abortion care. Still, not all of them understand the role of policies and laws developed by the government. Some people are unsatisfied with the current healthcare policies and post-abortion care offered to women who have undergone unsafe abortions (Wu et al., 2015). Therefore, the investigation and improvement of existing policies regarding post-abortion care play an important role in making sure that people not only use the laws and policies for their own good but can also study them and avoid making mistakes. At the moment, post-abortion care programs are not perfect. Still, a number of governmental organizations and agencies like USAID have focused on funding post-abortion care programs in order to increase women’s access to family planning and to reduce the number of unintended pregnancies and repeat abortions (Curtis, 2007).
Level of the Problem
Abortion and post-abortion care have become problems of a national and international level, especially because a large number of women worldwide could be in need of these services throughout their lives. In this project, the goal is to investigate different aspects of U.S. policy and its impact on women and other stakeholders. The major point is that although the U.S. government pays much attention to post-abortion issues worldwide, the country itself faces challenges with local healthcare providers who cannot perform the required procedures or cover the costs of abortion and post-abortion care. Indeed, women with low incomes and the inability to use their Medicare or Medicaid insurance face many challenges when seeking appropriate abortion-related medical care to protect and improve their health.
Stakeholder Analysis
Importance of Stakeholder Analysis
Post-abortion care policies involve different groups of people including non-governmental organizations, government agencies, hospitals, and families. To understand the role of each stakeholder, it’s helpful to use stakeholder analysis as the main tool to identify the actors and to describe their characteristics (Jepsen & Eskerod, 2013). Stakeholders are the people who have a connection to a particular project and could gain or lose something during or as a result of the project. These people have an interest in policy outcomes due to their limited resources of time, money, or knowledge (Seavey, McGrath, & Aytur, 2014). Therefore, stakeholders try to prioritize their activities and make decisions regarding their current needs and expectations from the policy.
Post-abortion care is an integral part of reproductive health. As soon as women have abortions, they need a significant amount of post-abortion care. Therefore, women are the main stakeholders of this policy because they are the main recipients of the outcomes of the policy. At the same time, the government and medical centers play an important role in the policy because of their abilities to promote, restrict, or support post-abortion care for women. Stakeholders demonstrate different biases and interests that can influence policy decisions toward a more appropriate direction based on clinical or scientific evidence (Lemke & Harris-Wai, 2015). In general, the importance of stakeholder analysis lies in the opportunity to identify people who could benefit or lose something as a result of the implementation of the identified policy.
Interest Groups of the Analysis
In the discussion of this problem, there are always people who support the idea of abortion and post-abortion care and people who cannot or do not support it. Still, people should understand that post-abortion care and abortion are two different issues and that they should be discussed from different perspectives. Different stakeholders form a policy community consisting of several interest groups that play an active role in the policymaking process (Longest, 2010).
In post-abortion care policy, there are several interest groups:
- Women, who are the direct recipients of the post-abortion care policy and services including physical, emotional, and psychological help;
- Medical organizations like hospitals and medical centers that have to investigate the conditions of patients and determine the quality and amount of care appropriate for a particular woman;
- The government, which has a huge influence on the promotion of post-abortion care for women and general reproductive health, family planning, and quality of life;
- Social workers who have to investigate the current state of affairs and the reasons why women choose to have abortions; and
- Media sources including newspapers, bloggers, and online forum participants who discuss the importance of the post-abortion care policy.
Support and Opposition to the Policy
Support of post-abortion care is strong indeed because it helps women and their families survive the outcomes of abortion and improve their own reproductive healthcare. However, there are also prominent groups of people who oppose the idea of post-abortion care and point to its inappropriateness for women and society. Social workers, who have the right to investigate reasons for abortion, are the main representatives who tend to oppose the policy. They explain their negative attitudes toward the policy of post-abortion care using facts and reasons why women agree on abortion.
There are situations in which women decide to have an abortion without informing their partners, weighing the opportunities, or considering the ethical aspects of their decisions. If women choose to have an abortion and want to ask for post-abortion care, they have to introduce a number of explanations and grounds. Social workers cooperating with the government could investigate each case in particular and explain when women are able to access free post-abortion care. Women, hospitals, and medical centers tend to be the supportive stakeholders because they will achieve a number of positive outcomes if the government supports the chosen policy. Women could have access to some free medical services after their abortions, and medical centers and hospitals could improve their services and hire more specialized people to provide post-abortion care.
Policy Formulation
Policy Solutions
While developing a post-abortion care policy, policymakers have to identify the common reasons for abortion, the personal and healthcare needs of patients, and the abilities of hospitals or other medical organizations to take care of their patients effectively. The policy should consider the needs of all stakeholders as well as the steps that could lead to the positive results of providing post-abortion care. For example, because treatment is one of the main elements in post-abortion care, the treatment of injuries and illnesses caused by abortion formulate the core of the policy. However, other important related issues to consider include possible delays in treatment, facility equipment, professional staff, family planning guidelines, and the respect and compassion of the healthcare organization. Women, as the direct recipients of the services related to the policy, should have access to counseling; contraceptive, reproductive, and family planning services; and organizations that aim at preventing unwanted pregnancies and explaining what women can do to avoid abortion, unwanted sexual experiences, or unpleasant outcomes. Over 230 million women lack access to the basics of reproductive care like contraception and the right to choose, meaning that they cannot control their lives or plan their own futures (Melesse, 2016). The policy of post-abortion care is a chance to solve some of the problems of female choice and social freedoms.
Previous Policy Options
The analysis of previous policy options is the analysis of existing laws and policies on the same issue. Regarding the statutory requirements and policies of the United States, there are a number of laws and amendments concerning abortion and post-abortion care. Previous policy options are also effective because they focus on injuries and treatment connected with post-abortion care. The existing laws show what people think about abortion and the importance of post-abortion care and determine the path toward the development of a new policy.
Political Circumstances
For a new policy on post-abortion care to be approved, politicians have to solve a number of questions. First of all, politicians should be concerned about this issue because unsafe abortion and inadequate post-abortion care are the main contributors to maternal mortality; as such, the development of special laws and funds can help protect human rights and improve quality of life. However, the Helms Amendment (1973) outlaws the use of U.S. foreign assistance funds to provide abortion and post-abortion care. The USAID post-abortion care policy (2001) aims at clarifying this type of care as treatment for people who have undergone legal or illegal abortion. It is clear that a number of political, bureaucratic, and social barriers exist in the promotion of post-abortion care (Barot, 2014). For example, drugs are important for the treatment of women after abortions, but politicians have to legalize drugs to achieve success in treatment.
Policy Costs
The determination of policy costs is the step that helps policymakers understand if the country is ready for the policy and what expenses could be applicable on the local and national levels. Examples from different countries show that the provision of post-abortion care costs about 10 to 15 million USD per year. An analysis of U.S. financial accounts and funds and post-abortion care outcomes reveals that the U.S. government could win a lot by supporting the policy and promoting safe abortion and better post-abortion care for the citizens of the United States.
Policy Financing Option
The development of a new policy provides the opportunity to introduce a new financing approach in order to consider the latest technological innovations and involvement of people in the discussion of the problem. However, it is also important to understand that past financial experiences could help policymakers make the right decisions and investigate the policy’s potential advantages and disadvantages. The government took responsibility for the development of financial support for the policy of post-abortion care in 2001. The same financial approach is appropriate for the new policy. Still, a new financial method that includes payments from the patients themselves could help promote the policy and attract the attention of those people who cannot use their own insurance or governmental support. Another method of financing the policy could come from increased taxes.
Bill Introduction
The new bill would be designed to solve the questions of post-abortion care by providing a set of written solutions, rules, and regulations. The purpose of the bill would be to promote the ideas of contraception, appropriate treatment, on-time consultations and diagnoses, and counseling to better meet women’s psychological and physical needs. For the purpose of the bill, post-abortion care should include services and support for women regardless of income level and personal identification of needs and help. The Senate and the House of Representatives include 20 standing committees and a number of subcommittees that facilitate the work of the committees (Longest, 2010). To pass the current policy’s bill calls for its assignment to two legislative committees (to the Committee on Ways and Means in the House and to the Committee on Finance in the Senate) and four subcommittees on health for further consideration and debate.
Policy Implementation
Policy Level
To ensure its appropriateness, the implementation of the policy should occur at the local level first and then at the state level. First of all, it is necessary for medical centers and hospitals to understand their roles in the lives of women who have chosen to have abortions and who have experienced the outcomes of safe and unsafe abortions. There have been many examples of medical negligence when women have undergone illegal abortions and have then been unable to access post-abortion care. The post-abortion care policy in question should not depend on the conditions of or the reasons for abortion. The implementation of the policy at the state level would help provide low-income women with the possibilities to get high-quality abortion-related services from the government.
Legislative Committees
The Senate and the House of Representatives are the main legislative committees that have oversight of the policy in order to clarify if the women who have undergone abortions, as well as their families, comprehend their rights and understand their needs. Both committees play an important role in the process of policy implementation because they take responsibility for the legal, financial, and social aspects of the policy and its acceptance by people and all stakeholders.
Policy Agencies
A number of obstacles stand in the way of the success of any abortion-related policy, and social involvement is the best solution. Direct contact between the members of Congress and their staffs, as well as the executive branch personnel who deal with policy implementation, is a good first step toward a solution to these problems. Each committee of the House and the Senate has its own oversight responsibilities, and properly organized contact between different agencies is the key to the long-term success of the policy.
Rules and Regulations in the Policy
There are two main rules in the implementation process. First, all women, regardless of income level, would be able to ask for post-abortion help by proving their recent abortion and their need for such type of care. The second rule touches upon the possibility that other stakeholders could also ask for assistance in post-abortion care. For example, the family members of a woman who chose to have an abortion could request professional help with their own psychological and emotional needs. In this way, counseling for psychological and physical needs is the second regulation for consideration.
Stakeholders’ Concerns
Stakeholder concerns about the role and value of post-abortion care largely arise because not all people understand the goals of such care and the importance of spending money on its promotion. The policy would provide a chance to explain that different people (not only women after abortion) would be able to ask for post-abortion care and to demonstrate how the government is meeting their needs in order to promote a high quality of life for all citizens.
Policy Impact on Stakeholders
The impact of the policy is considerable indeed because it helps organize the work of hospitals and other medical organizations and define the rights of patients and their families. The government could benefit from the policy because of the possibility to influence human lives and improve the quality of life. Women would have better defined rights and would have access to appropriate treatment in case they face injury or other health problems after abortions. Social workers would have to investigate the reasons for abortion and clarify what makes women choose abortion.
Implementation Issues
Post-abortion care policy is a chance to prove that reproductive health is important, and the government should demonstrate its care for its people and their physical and emotional well-being. Abortion is an issue that touches a number of lives at the same time. People are wrong to believe that women are the only recipients of the policy because its implementation would also have an impact on family members related to the woman who decides to have an abortion. Post-abortion care should not be about the treatment of physical injuries only because emotional and psychological needs significantly influence human lives as well. People have to understand the various aspects of a comprehensive post-abortion treatment and care program.
Policy Evaluation
Policy Analysis
Policy analysis includes understanding the opinions of ordinary people about the importance of post-abortion care and the readiness of different medical organizations to provide patients with treatment and support. There are several types of policy analysis that could help understand how to achieve the goals of the policy in the best way. In this policy, ex-post policy analysis is the best solution because this method helps determine the real value of the chosen policy and clarify to what degree public understanding of the offered policy’s objectives has occurred through its implementation.
Evaluation Methods
One of the best ways to evaluate the policy option is to pay attention to the opinions of the stakeholders of the policy. Questionnaires and interviews of the general public and people at hospitals should help gather personal opinions about the necessity of the policy. These surveys could be based on a simple Likert scale questionnaire and a tally of the total number of positive and negative answers. Moreover, gathering statistical data will reveal whether the effects of the policy have actually helped change the situation and have improved the quality of life. Data regarding the number of abortions performed and complaints concerning the quality of or access to post-abortion care could prove whether the policy works or not and whether it has positively influenced the current state of health affairs.
Policy Modifications
The policymaking process is not perfect, and modifications help change the level of policy implementation over time (Longest, 2010). As the policy is implemented, all stakeholders could search for some modifications in order to increase their benefits. For example, some modifications of the policy under consideration could be based on feedback from stakeholders, an analysis of the consequences of the policy, and an identification of the predicted future impact of the policy.
Policy Recommendations
Future recommendations include understanding the importance of knowledge about post-abortion care, the reasons why people could be in need of post-abortion care, and the outcomes that post-abortion care could have on people. People should know what post-abortion care includes and be able to identify their needs and the needs of other stakeholders. Moreover, the government, as another important stakeholder of the policy, has to develop effective financial operations that would allow women and other people who may need post-abortion care to seek help from a hospital or some other medical provider.
In general, the process of formulating, implementing, and evaluating this policy will help clarify what specific concerns occur around post-abortion care and what improvements can made to make the policy more effective and positively impact stakeholders’ lives. Improving post-abortion care policy is a chance to further family planning initiatives, provide necessary medical care for women who have had abortions, and improve the quality of life for many different people in society.
References
Abort73. (2016). U.S. abortion statistics. Web.
Barot, S. (2014). Implementing Postabortion care programs in the developing world: Ongoing challenges. Guttmacher Institute. Web.
Curtis, C. (2007). Meeting health care needs of women experiences complications of miscarriage and unsafe abortion: USAID’s postabortion care program.” Journal of Midwifery & Women’s Health, 52(4), 368-375.
Jepsen, A.L., & Eskerod, P. (2013). Project stakeholder management. Burlington, VT: Gower Publishing.
Lemke, A.A., & Harris-Wai, J.N. (2015). Stakeholder engagement in policy development: Challenges and opportunities for human genomics. Genetics in Medicine, 17(12), 949-957.
Longest Jr, B.B. (2010). Health policymaking in the United States. Chicago, IL: Health Administration Press.
Melesse, T. (2016). The right to plan your own future. The Huffington Post. Web.
Seavey, J.W., McGrath, R.J., & Aytur, S.A. (2014). Health policy analysis. New York, NY: Springer Publishing Company.
The Henry J. Kaiser family foundation. (2016). The U.S. government and international family planning & reproductive health: Statutory requirements and policies. Web.
World health organization. (2015). Health worker roles in providing safe abortion care and post-abortion contraception. Web.
Wu, J., P., Godfrey, E.M., Prine, L., Andersen, K.L., MacNaughton, H., & Gold, M. (2015). Women’s satisfaction with abortion care in academic family medicine centers. Family Medicine, 47(2), 98-106.