When making decisions about abortion care, people must weigh multiple dimensions of care. New research suggests that wait time and cost may matter most for potential patients.
Many researchers have examined abortion patients’ preferences for individual aspects of care, such as the abortion method (that is, medication versus procedural abortion) and delivery model (for example, telehealth versus in-person care). However, that approach fails to account for the ways people must simultaneously consider multiple dimensions of healthcare when choosing care.
This study is the first to examine abortion preferences in the United States using an experimental design that asks participants to consider more than one dimension of care at the same time. UW Collaborative for Reproductive Equity researchers Jane Seymour and Jenny Higgins led the work in collaboration with Sarah Roberts from Advancing New Standards in Reproductive Health at the University of California, San Francisco. The findings were recently published in the journal Contraception.
“To meet peoples’ abortion preferences, we must understand how their needs and desires for different domains of care interact to influence decision-making,” Seymour explains.
This study is the first to examine abortion preferences in the United States using an experimental design that asks participants to consider more than one dimension of care at the same time.
Thus, the researchers set out to assess which dimensions of abortion care most affect decision-making among people in the U.S. with the capacity for pregnancy.
In July 2022, the team surveyed a sample of people assigned female sex at birth, ages 18-55, living in the U.S. The survey included a discrete choice experiment to assess abortion care preferences among respondents. Participants were presented with several options for first-trimester abortion care that varied by five dimensions of care:
- Method (medication versus procedural abortion)
- Distance
- Wait time for appointment
- Delivery model (telehealth versus in-clinic)
- Cost
Participants were then asked to select which of the options they would prefer.
Using this experimental design, the study team was able to determine that for these survey respondents, cost and wait time had a greater effect on hypothetical abortion care decision-making than did distance to care, abortion method, and delivery model.
The takeaway: Focusing solely on clinical aspects of abortion care, such as the method or delivery model, may ignore other attributes of care that are particularly important for potential patients.
For context: Although the cost of and wait time for care appeared to have the greatest influence on abortion decision-making for those in this study, many states impose policies that negatively affect these domains of care. Most states, including Wisconsin, have policies that prohibit Medicaid and some other health insurance providers from covering abortion care costs. So even if someone in Wisconsin has health insurance, they must pay out of pocket for abortion care. This cost can put abortion care out of reach for many, and it remains one of the most significant barriers to care in our state.
Additionally, in some states, including Wisconsin, mandatory waiting periods delay the time to an appointment. Furthermore, delays in care can lead to needing an abortion later in pregnancy, which is more expensive and harder to obtain than an abortion earlier in pregnancy.
Looking ahead, Seymour is collaborating with CORE investigator Tiffany Green and collaborators to use this same experimental design to understand what dimensions of abortion care influence decision-making among Black birthing people. Racial and ethnic variation in abortion method preferences is largely unstudied. It is critical to understand and address Black people’s abortion care preferences, especially considering the unique structural barriers to care they face.