Dr. Abigail Aiken, an assistant professor at the LBJ School of Public Affairs, has dedicated her career to researching factors that affect sexual and reproductive health, including one of the most highly charged issues in society, access to abortion.
“It's very emotionally charged,” says Aiken, an expert in reproductive health. “I think data and scientific evidence can provide some common ground for discussion.”
Aiken grew up in Northern Ireland and received a bachelor’s degree and a medical doctorate from the University of Cambridge, Trinity College, before moving to the United States and receiving a master’s in public health from Harvard University and a doctorate in public policy from The University of Texas at Austin’s LBJ School, where she now teaches. She currently serves on the Board of Managers of Central Health, Travis County’s health care district, which provides the community’s uninsured, underinsured and low-income residents with access to high-quality, cost-effective health care.
Aiken moved from clinical medicine research to policy research to better influence how health laws and regulations are designed. Her goal is to improve care for as many people as possible.
“What's the evidence behind our health laws? Are there any gaps that we might be able to fill to help improve them?” she asks. “And what are the impacts of these policies on people who need services?”
Her current research evaluates the effects of policies that restrict access to abortion as a means of reducing the number of abortions.
“Are we actually seeing a reduction in the number of abortions? Or are we seeing a shifting of where abortions take place from the clinical setting to outside of the formal health care setting?” she asks. “And if women are seeking options outside of clinics, how safe and effective are those options?”
Evaluating the Safety of Virtual Care
In a recent study, Aiken focused on her home region, Ireland. Abortion laws in the Republic of Ireland and in Northern Ireland are among the most restrictive across the globe. A woman who seeks an abortion could face up to 14 years in prison in the Republic of Ireland and a maximum criminal penalty of life in prison in Northern Ireland.
“So that's where my research is focusing, trying to get a handle on what happens when people can't get access to an abortion,” Aiken says. “Does that mean that they change their minds, or does that mean they look for some other way to do it? And if the latter, is there a public health imperative to make that as safe for people as possible?”
In a recent study, Aiken found that an increasing number of Irish and Northern Irish women from all sectors of society were accessing abortion services using online telemedicine – like Women on Web (WoW).
“And that's an issue of concern for those who are interested in public health and public policy, because we're not entirely sure what that experience looks like for the patient,” she said.
In October 2017, Aiken testified before the Irish parliamentary committee responsible for deciding the scope of the 2018 referendum to legalize abortion in Ireland, presenting both her research on the experiences of women accessing abortion services through online telemedicine and the outcomes of their abortions.
Health Policy is Very Siloed
Her analysis of more than 5,000 women who used WoW found rates of effectiveness that are comparable with in-clinic procedures and very low complication rates.
But these numbers alone aren’t enough to affect policy, Aiken says. “You also want to understand what was this like for someone in the context of their life.”
To do that, Aiken is collaborating with statisticians, clinicians, economists and sociologists.
“I think a lot of the time you look at how we make policy and how we produce research, and it's very siloed,” she says. “But collaboration is important to produce policy scholarship that people in the real world are going to care about and will actually use. I think the best way to do that is to involve all angles of the issue.
“You know there are folks who are never going to agree on the ethical or the moral issues, and there'll be folks who are never going to agree on the economic issues,” Aiken says. “But there is a value to providing objective evidence as a basis to at least start the conversation.”