ABORTION CARE: USA – Who gets the abortion method they prefer?

by Thomas K, Bornstein M, Odum T, Bessett D, Norris Turner A, Rivlin K

Contraception  Vol 134, June 2024   (Not open access)

Introduction – Medication and procedural abortions are safe and effective methods for people seeking to end a pregnancy, with medication abortion accounting for just over half of abortions in the United States. Personal and pragmatic reasons may influence decision-making about the method of abortion. Abortion restrictions and other obstacles can also limit access to a preferred method, with such limitations disproportionately experienced by communities experiencing structural barriers to care. We sought to better understand the relationship between method of abortion preferred and method received among patients seeking care in three states with restrictive abortion policies: Ohio, West Virginia, and Kentucky.

Method – From April 2020 to April 2021, we recruited individuals seeking abortion care from 14 health centers in Ohio, West Virginia, and Kentucky to complete an online survey about their experiences. We queried the type of abortion received and whether this was their preferred method. Our analytic sample included 1,420 respondents who provided complete responses to method and preference (81.4% of the enrolled sample). Using χ2 tests and F tests, we examined associations between sociodemographic characteristics including age, race, ethnicity, and level of education, and abortion characteristics such as self-reported gestation at the time of the abortion, and two outcomes: 1) abortion method received and 2) receipt of preferred abortion method.

Results – The majority of respondents were between 18-29 years (69.4%). About a third were Black (33.7%) and half were White (52.7%). The mean gestation at termination was 57.3 days (median=52, range=7-147 days). Just over half received a procedural abortion (53% procedure, 47% medication). Most respondents (89.7%) indicated that the abortion method they received was their preferred method. The greatest alignment between method received and preferred method was among those who received medication abortion. Nearly all (99%) of those who received medication abortion said that they preferred medication, while 81.4% of those who received a procedural abortion preferred a procedure (p<0.001).

There were few differences in preferred method by sociodemographic characteristics. Just over half of Black respondents preferred procedural abortion (52.3%) compared to 36.9% of White respondents (p<0.001). Respondents who preferred a procedural abortion also tended to be further in pregnancy (mean=61 days) than those who preferred medication (mean=54.5 days) (p<0.001). Those who received their preferred method were, on average, 54.6 days pregnant compared to 80.3 days for those who did not receive their preferred method (p<0.001).

Conclusions – We found differences by race in abortion method preference with a higher proportion of Black individuals preferring procedural abortion. Access to procedural abortion remains vital to providing care that aligns with patient preferences. Individuals who did not receive their preferred abortion method were more likely to be further in pregnancy and to have preferred medication and received a procedure. Barriers to care may prevent individuals from accessing a preferred method, particularly medication abortion. Reducing barriers and maintaining access to both procedural and medication abortion is necessary to providing patient-centered abortion care.