Abstract
Most studies of abortion access have recruited participants from abortion clinics, thereby missing people for whom barriers to care were insurmountable. Consequently, research may underestimate the nature and scope of barriers that exist. We aimed to recruit participants who had considered, but failed to obtain, an abortion using three online platforms, and to evaluate the feasibility of collecting data on their abortion-seeking experiences in a multi-modal online study. In 2018, we recruited participants for this feasibility study from Facebook, Google Ads, and Reddit for an online survey about experiences seeking abortion care in the United States; we additionally conducted in-depth interviews among a subset of survey participants. We completed descriptive analyses of survey data, and thematic analyses of interview data. Recruitment results have been previously published. For the primary outcomes of this analysis, over one month, we succeeded in capturing data on abortion-seeking experiences from 66 individuals who were not currently pregnant and reported not having obtained an abortion, nor visited an abortion facility, despite feeling that abortion could have been the best option for a recent pregnancy. A subset of survey respondents (n = 14) completed in-depth interviews. Results highlighted multiple, reinforcing barriers to abortion care, including legal restrictions such as gestational limits and waiting periods that exacerbated financial and other burdens, logistical and informational barriers, as well as barriers to abortion care less frequently reported in the literature, such as a preference for medication abortion. These findings support the use of online recruitment to identify and survey an understudied population about their abortion-seeking experiences. Further, findings contribute to a more complete understanding of the full range of barriers to abortion care that people experience in the United States, and how these barriers intersect to not just delay, but to prevent people from obtaining abortion.
Highlights
In the United States, people have difficulty accessing abortion care because of a range of barriers, including cost of services and ancillary expenses; gestational age restrictions; legal restrictions; long distances to care; and lack of abortion-related information [1–12]
Recognizing the limitation of recruiting only from abortion clinics, a study in Louisiana and Maryland concluded that recruitment in prenatal clinics is a feasible way to find people who considered, but did not obtain, an abortion [14]; approximately onethird of participants considered, but did not obtain an abortion, citing personal preferences and policy-related barriers
Between August 15 and September 15, 2018, we recruited for a brief online survey through advertisements on Facebook, Google Ads, and two Reddit threads
Summary
In the United States, people have difficulty accessing abortion care because of a range of barriers, including cost of services and ancillary expenses; gestational age restrictions; legal restrictions; long distances to care; and lack of abortion-related information [1–12] These barriers have negative consequences individually [5], people seeking abortion often experience them in combination, which compounds their effect [13]. Even the expansion to prenatal clinics may still miss portions of the target population, including people who miscarry, who have not yet entered into care, or who feel they have no source of care or cannot access care without increasing risks of deportation or other privacy concerns Addressing many of these concerns, a recent study recruited currently pregnant participants searching for information on abortion from Google Ads: at the one-month follow-up, less than half of participants (48%) had had an abortion [15,16]
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