Real-Time Effects of Payer Restrictions on Reproductive Healthcare: A Qualitative Analysis of Cost-Related Barriers and Their Consequences among U.S. Abortion Seekers on Reddit.

Jenny A Higgins,Madison Lands,Taryn M Valley,Laura Jacques,Emma Carpenter

doi:10.3390/ijerph18179013

Abstract

Objective: The Hyde Amendment and related policies limit or prohibit Medicaid coverage of abortion services in the United States. Most research on cost-related abortion barriers relies on clinic-based samples, but people who desire abortions may never make it to a healthcare center. To examine a novel, pre-abortion population, we analyzed a unique qualitative dataset of posts from Reddit, a widely used social media platform increasingly leveraged by researchers, to assess financial obstacles among anonymous posters considering abortion. Methods: In February 2020, we used Python to web-scrape the 250 most recent posts that mentioned abortion, removing all identifying information and usernames. After transferring all posts into NVivo, a qualitative software package, the team identified all datapoints related to cost. Three qualitatively trained evaluators established and applied codes, reaching saturation after 194 posts. The research team used a descriptive qualitative approach, using both inductive and deductive elements, to identify and analyze themes related to financial barriers. Results: We documented multiple cost-related deterrents, including lack of funds for both the procedure and attendant travel costs, inability to afford desired abortion modality (i.e., medication or surgical), and for some, consideration of self-managed abortion options due to cost barriers. Conclusions: Findings from this study underscore the centrality of cost barriers and third-party payer restrictions to stymying reproductive health access in the United States. Results may contribute to the growing evidence base and building political momentum focused on repealing the Hyde Amendment.

Highlights

A frequently sought healthcare procedure, abortion can be very challenging to obtain in the U.S Barriers include a sociopolitical landscape of abortion restrictions and clinic closures, deep-set cultural stigma, and difficulty traveling to the nearest abortion clinic [1]
In this study of Reddit posters, we found multiple financial barriers faced by people seeking abortions
Cost-related prohibitions are likely the largest obstacle to abortion access, especially for individuals who face the greatest social inequities. Even those who have insurance coverage face obstacles, which can delay if not avert procedures [4]. Findings from this analysis of anonymous Reddit posters suggest that cost barriers led some to consider illegal and, in some cases, harmful self-managed abortion techniques

Summary

Introduction

A frequently sought healthcare procedure, abortion can be very challenging to obtain in the U.S Barriers include a sociopolitical landscape of abortion restrictions and clinic closures, deep-set cultural stigma, and difficulty traveling to the nearest abortion clinic [1]. One of the most powerful obstacles to abortion care is cost [2,3]. Illinois Representative Henry Hyde and colleagues attached a cost-related provision to the appropriations bill for the Departments of Labor, Health, Education, and Welfare Known as “the Hyde Amendment”, this provision ended federal funding, including Medicaid funding, for abortion. In the years between Roe’s passage and the implementation of the Hyde Amendment, approximately one in three abortions were paid

Methods

Results

Discussion

Conclusion