Abigail Aiken

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Research

My current research interests encompass three main areas:
1) Abortion outside the formal healthcare setting
2) Unintended pregnancy
3) Contraceptive desires and access

Abortion outside the formal healthcare setting

In many parts of the world, abortion is highly restricted by laws and policies. Yet women still require access to abortion and find ways to self-source abortion medications and use them outside the formal healthcare setting. Focusing on Northern Ireland, Ireland, the United States, and Latin America, the overarching goals of my work in this area are to:
1) inform strategies to increase access to safe and supported at-home abortion in areas where abortion is unavailable or highly restricted
2) provide evidence that can shape the policy conversation.

Unintended pregnancy

Unintended pregnancy has long been a major public health issue in the United States. The public discourse and policy conversation often focuses on unintended pregnancy solely as a negative and stigmatizing behavior, calling for women to adhere to a strict planning paradigm, where timing-based pregnancy intentions are essential and plans are made to follow through on those intentions. Yet for many women, their thoughts and feelings about pregnancy are not nearly so straightforward. For some women, the normative social ideals that dictate whether or not one is “ready to parent” are unattainable, for others, positive feelings about children clash with lack of economic resources. In short, the story of unintended pregnancy is often a lot more complex than it seems. The goal of this research is to bring women’s actual attitudes and experiences to the forefront of the policy conversation. In doing so, we suggest that is it not “unintended pregnancy” we should focus on preventing, but undesired pregnancy.

Contraceptive desires and access

This aspect of my research investigates international, national, and state policies affecting access to contraception, abortion, and reproductive health services. As part of the Texas Policy Evaluation Project (Tx-PEP), I have been engaged in projects describing how legislative budget reductions in public funding for family planning in Texas affect the ability of clinics to provide services and the ability of women to obtain their desired methods of contraception.

The postpartum and post-abortion periods offer opportunities for women to access the healthcare system and providers to engage in shared contraceptive decision-making. Yet these key times are often overlooked in research aiming to improve access to contraception and reduce unintended pregnancy. In collaboration with domestic and international colleagues, I have examined system-level barriers affecting postpartum access to highly effective long-acting reversible methods of contraception via Medicaid in the U.S. and via the National Health Service (NHS) in the UK, and evaluated programs to improve access.

Evidence-Based Obstetric Practice

I also work with a number of clinical collaborators interested in informing good obstetric practices. Clinical guidelines and practice norms for managing prolonged labor due to fetal malposition vary widely by country. In the U.S, Cesarean section is the default mode of management. In the U.K, obstetric instruments including forceps and ventouse are available as alternatives to Cesarean section. In collaboration with clinical colleagues in the U.K., this aspect of my research compares maternal and neonatal outcomes for complex deliveries conducted using obstetric instruments versus Cesarean section and examines the factors influencing success. Findings support not only the safety of instrumental delivery, but also several benefits for maternal health over Cesarean delivery.