When the Supreme Court overturned Roe v. Wade, it opened the door for states to ban abortion, making care even more difficult to access. At the same time, access to medication abortion has exploded thanks to regulatory changes that eliminate the need for an in-person clinic visit.
A new paper looks at how to best provide medication abortion care that meets people’s needs in the southeastern US in this new complex landscape.
There’s a whole spectrum of medication abortion options that exist outside of the health system, with different degrees of contact with clinicians and other support. The cost of those varies widely, from no cost to hundreds of dollars.
A new UCSF study by Hannah Leslie, PhD, Kelsey Holt, ScD, and their colleagues at the reproductive justice organization Mississippi in Action used in-person surveys in Mississippi and online surveys in Mississippi, Georgia, Alabama, and Louisiana to identify what was most important to people when choosing a way to have a medication abortion. These are all states that ranked low in comprehensive reproductive health care before the Dobbs decision overturning Roe v. Wade, are home to large Black communities that face systemic injustice, and whose legislatures have enacted strict or total abortion bans.
The discrete choice experiment was designed to estimate real-world trade-offs people make when deciding how to get a medication abortion. It focused on considerations like where the pills came from, whether they included a care package, how support during the procedure was provided (e.g., via an information sheet vs. in-person from a doula), and out-of-pocket costs.
Out-of-pocket cost was the most important factor in people’s decisions. It was nearly as important as the three other attributes combined.
Material support in the form of an essential care package (including pain and nausea medication, menstrual pads, and a pregnancy test) or self-care package (including essentials plus items to increase their comfort, such as candles and essential oils) was preferred, especially when costs remain below $50. While it was considered less important than cost and material support, the medication source and how support was provided still influenced decisions. In-person Mississippi respondents preferred to receive pills from a community network or to receive support from a doula. Online participants preferred accessing pills online and receiving support as needed during the experience in a clinic.
This study provides new insights into the preferences of people who might need a medication abortion in four states with total or six-week abortion bans. Over 70% would consider a medication abortion if needed in the future. Their preferences for services show that it’s important to meet needs beyond access to medications, with priorities for low-cost models with material support, such as essential care items or additional self-care items. Most people are willing to consider multiple options to meet their needs. This research adds to our understanding of medication abortion preferences in states where care is not available or severely limited.