As state legislatures across the US enact abortion restrictions, access to abortion care is increasingly jeopardized. These restrictive state-level policies create multiple social, logistical and financial barriers to abortion, and in some cases make it impossible for people to obtain one. Much of the previous research on the obstacles to accessing abortion care has not been able to reach people who are seeking abortion but never make it to an abortion provider.

ANSIRH researchers used a new approach to this research in their Google Ads Abortion Access Study. They showed an ad for a survey to people searching online for abortion care who were considering an abortion. People who filled out the survey received a follow-up survey four weeks later.

Researchers found that people living in states with restrictive abortion policies were more likely to continue pregnancy when interviewed 4 weeks later. Those living in a state without Medicaid abortion coverage were more likely to report barriers to abortion and were still trying to obtain care four weeks later.

In the follow-up survey, nearly half (48%) of people seeking information about abortion online said that they had had an abortion, about one-third (32%) were still trying to get an abortion, and 20% were planning to continue their pregnancies. People in restricted access states had significantly higher odds of planning to continue the pregnancy at follow-up than participants in protected access states. Those living in restricted access states were more likely than those living in other states to report having to travel a long distance and having to arrange for childcare as barriers

Structural barriers to abortion, including state-level restrictions, can be particularly challenging for low-income people to overcome. Delaying an abortion makes the procedure more expensive, leading to a perpetual cycle of fundraising until the clinic or state gestational limit is reached and it is too late. Medicaid coverage of abortion is a critical step in ensuring that those who want abortions can obtain them.