Determinants of demand: Method selection and provider preference among United States women seeking abortion services.

Abstract

Access to abortion services in the United States has become increasingly constrained over the past decade. Medication abortion has the potential to increase abortion availability, primarily through new provider networks, but without a better understanding of how and why women make decisions regarding both their abortion method and provider, expansion efforts may be misguided and valuable resources wasted. An exploratory study was undertaken to investigate method and provider preferences. Semi-structured one-onone interviews were conducted with 205 abortion clients at Planned Parenthood of Greater Iowa clinics. Both quantitative and qualitative analyses were carried out. Stigmatization of abortion is a driving force in how women make abortion-related decisions; this may help to explain why the majority of participants would not have wanted to obtain their abortion from their regular provider and many women were not even comfortable discussing the topic of abortion with them. Continuity with one's regular provider was not deemed important or desired by the majority of study participants. Two of the main reasons given for preferring the clinic over the private doctor were confidentiality and privacy; keeping the abortion a secret from one's parents was paramount for some of the younger participants. Study participants also discussed the lack of privacy in small town communities and related fears of confidential ities being breached as reasons for preferring the clinic setting. Travel time was not a predictor of preferring one's regular doctor over the clinic. Method selection was primarily based on process characteristics including duration of procedure or clinic visit, location (clinic vs. home), level of invasiveness, and pain. Many abortion clients feel strongly about their method of choice, and method preference was shown to trump any interest in one's regular doctor for the majority of women. Unexpectedly, participants who chose the aspiration procedure were more likely to have previous knowledge about the medication method than those choosing a medication abortion. Women at greater gestational age were more likely to choose aspiration over medication, even at 8 weeks or less. One quarter of participants claimed to have insurance that would cover abortion services, the vast majority of whom planned to use it.