Abortion Care Research Articles

Crisis management: pathways to crisis pregnancy centers

ABSTRACT Crisis pregnancy centers (CPCs) provide social support, material aid, and counseling against abortion. We evaluated the perspectives of CPC clients to understand how they found the CPC that they attended for services. In 2019, we conducted in-depth interviews with 21 clients of 10 CPCs in Ohio, who were recruited from the CPC (n = 9) or an abortion clinic (n = 12), to understand their experiences attending the center. This analysis focused on the ways in which pregnant people end up as clients at a CPC seeking assistance instead of attending another setting, such as a medical center. We identified two pathways through which clients find CPCs. First, in the internet pathway, clients needing abortion services found CPCs via internet search for pregnancy symptoms, abortion care, or ultrasound services. Second, in the social safety network pathway, clients needing material aid found CPCs through recommendations from trusted others and due to the proximity of CPCs to their homes. Structural conditions influence the pathways clients pursue, such as the need for healthcare services and material aid. Future research should further explore the demographics of those who attend CPCs and motivations for attendance.

Socio-ecological influences on access to abortion care in Costa Rica: a qualitative analysis of key perspectives from clinical and policy stakeholders

Costa Rica prohibits abortion except under narrow circumstances to save the pregnant person’s life. The country boasts historically strong support for social policy and human rights, while also presenting a complex and restrictive abortion access landscape. From September 2021 to March 2022, we conducted 23 interviews with obstetrician-gynecologist (OB/GYN) physicians, OB/GYN medical residents, and policy stakeholders to explore the socio-ecological influences on abortion access in Costa Rica. We sampled clinicians and policy stakeholders from the Universidad de Ciencias Médicas listserv through snowball sampling and conducted semi-structured in-depth interviews in Spanish. We identified limited access to comprehensive sexual health education, lack of support from interpersonal networks, inadequate provider knowledge and training, financial and migratory status, and both provider and community stigma as substantial barriers to abortion access. This study addresses a gap in published research around the social determinants of abortion in Costa Rica and sheds light on the attitudes and opinions of the medical and policy stakeholder communities about abortion access. The results highlight the need for expanded access to comprehensive sexual health education, abortion-related training for healthcare providers, and increased programming efforts, such as funding, outreach, and implementation, to ensure comprehensive reproductive health services are available and accessible, especially for vulnerable populations in Costa Rica.

Virtual Clinic Telehealth Abortion Services in the United States One Year After Dobbs: Landscape Review.

Telehealth abortion has taken on a vital role in maintaining abortion access since the Dobbs v. Jackson Women's Health Organization Supreme Court decision. However, little remains known about the landscape of new telehealth-only virtual clinic abortion providers that have expanded since telehealth abortion first became widely available in the United States in 2021. This study aimed to (1) document the landscape of telehealth-only virtual clinic abortion care in the United States, (2) describe changes in the presence of virtual clinic abortion services between September 2022, following the Dobbs decision, and June 2023, and (3) identify structural factors that may perpetuate inequities in access to virtual clinic abortion care. We conducted a repeated cross-sectional study by reviewing web search results and abortion directories to identify virtual abortion clinics in September 2022 and June 2023 and described changes in the presence of virtual clinics between these 2 periods. In June 2023, we also described each virtual clinic's policies, including states served, costs, patient age limits, insurance acceptance, financial assistance available, and gestational limits. We documented 11 virtual clinics providing telehealth abortion care in 26 states and Washington DC in September 2022. By June 2023, 20 virtual clinics were providing services in 27 states and Washington DC. Most (n=16) offered care to minors, 8 provided care until 10 weeks of pregnancy, and median costs were US $259. In addition, 2 accepted private insurance and 1 accepted Medicaid, within a limited number of states. Most (n=16) had some form of financial assistance available. Virtual clinic abortion providers have proliferated since the Dobbs decision. We documented inequities in the availability of telehealth abortion care from virtual clinics, including age restrictions that exclude minors, gestational limits for care, and limited insurance and Medicaid acceptance. Notably, virtual clinic abortion care was not permitted in 11 states where in-person abortion is available.

Communication and Counseling Preferences of Women Who Chose Abortion During Adolescence: A Qualitative Study

Study ObjectiveAs part of a larger study about pregnancy options counseling with adolescents, we interviewed women in the United States who chose abortion during adolescence about preferences and experiences regarding communication from healthcare professionals during abortion care. Design, Setting, and ParticipantsWe conducted individual semi-structured interviews with women ages 18-35 years old who were pregnant before age 20 years old and chose abortion. We recruited participants through social media, a research registry, and flyers in healthcare facilities. We recorded and transcribed interviews. Two investigators coded interview transcripts using thematic analysis. ResultsWe conducted interviews with 17 US women (median age 32 years old, range 20-35 years old) from 11/2020-4/2021. The median age at time of abortion was 18 years old (range 14-19 years). The sample was 58% (n = 10) Caucasian and 65% (n = 11) heterosexual. Themes included: 1) Participants perceived options counseling before abortion as important and necessary but did not always feel they personally needed it. 2) Participants reported that clinicians including nurses, physicians, and other staff sometimes had poor bedside manner, which was not aligned with their perceived need for gentleness due to their adolescence. 3) Participants valued nonjudgmental communication including normalization of abortion care. 4) Participants desired privacy and confidentiality throughout their clinic appointment, but clinic logistics led to concerns about limited privacy. 5) Participants appreciated medically accurate information about abortion in plain language balancing safety and risk information for reducing fear before the procedure. ConclusionResponses suggested specific best practices that healthcare providers can adopt to improve care for youth considering abortion.

Placenta accreta spectrum in the second trimester: a clinical conundrum in procedural abortion care

Given the limitations in perioperative management strategies available at freestanding abortion clinics, abortion providers must commonly discern which patients are too complicated for procedural abortions at their center and must be referred for a hospital-based abortion. The need to transition from freestanding clinics to hospital-based abortion care can lead to delays in completing an abortion and significant social, economic, and psychological repercussions for the pregnant individual. One significant clinical problem that exemplifies the issue of who can be safely taken care of at a freestanding abortion clinic is when the placenta accreta spectrum is suspected. Placenta accreta spectrum is one of the major contributors to maternal morbidity and mortality in the United States, requiring coordinated multidisciplinary management to ensure the safest outcome for the pregnant individual. In this Clinical Opinion, we review the literature focused on identifying individuals at risk for placenta accreta spectrum >14+0 weeks gestation, delineate an algorithm to improve the frequency of timely referrals to hospital-based abortion providers, and propose next steps for future training goals and research on placenta accreta spectrum in the second trimester between complex family planning and maternal-fetal medicine subspecialists.

The Impact of the Dobbs v. Jackson Supreme Court Decision on Orthopaedic Residency Programs: A Collaborative Orthopaedic Education Research Group (COERG) Survey.

Recent changes inreproductive health care policy have now led to state-specific differences in abortion care access across the United States. Members of the medical community in particular have issued concerns regarding these new policies and their potential impact on graduate medical training. Objectives: The purpose of this study was to sample orthopaedic surgery residency programs to gauge their perceptions of the Dobbs decision and its impact on residency training. Materials and methods:A 25-item questionnaire was developed toassess the attitudes of orthopaedic surgery residency programs on the Dobbs v. Jackson Women's Health Organization decision. Our survey-based study was first endorsed by and then distributed amongst members of the Collaborative Orthopaedic Education Research Group (COERG). A total of 24 representatives from 24 Accreditation Council for Graduate Medical Education (ACGME) accredited orthopaedic surgery residency programs agreed to participate in the study. Results: Twenty-four of 24 program correspondents completed the survey (100%). Of the 15 programs (68.2%) who reported that their institution does not have a contingency plan in place, only five (33.3%) see a need for one. Eighteen programs (75.0%) agreed that the ACGME should have a policy protecting residents or significant others needing reproductive care. Ten (41.7%) respondents indicated that the Dobbs decision will impact how students rank residency programs; however, none (0%) believe it will impact their ability to attract a diverse applicant pool. Conclusion: Although some programs surveyed have a contingency plan in place, the majority believe the ACGME should develop a policy that addresses the reproductive needs of residents. Given the higher rate of pregnancy complications experienced by women training in orthopaedic surgery it is paramount to have policies that protect residents seeking reproductive care.

Sexual Violence, Disclosure Pattern, and Abortion and Post-Abortion Care Services in Displaced People's Camps in Africa: A Scoping Review.

Violent social and political conflicts have caused several challenges to internally displaced persons (IDPs), especially girls and young women, among which is sexual violence (SV). Despite extensive records on SV in humanitarian contexts, studies to assess the level, examine the disclosure pattern (DP) and evaluate the availability of abortion care in these settings have received inadequate attention. This scoping review sought to synthesise the current African-based research on SV, DP, and abortion and post-abortion care (APAC) in humanitarian contexts. We conducted a systematic search of five databases: MEDLINE, PubMed, Scopus, Embase and Google Scholar, where the articles retrieved met the criteria for inclusion. The review adhered to PRISMA guidelines and the Critical Appraisal Skills Programme (CASP), containing ten questions to help confirm the validity of the research design and the originality of the results in comparison with similar studies. A series of inclusion and exclusion criteria were applied after the search, and 35 eligible articles from ten African countries with evidence of sexual violence, disclosure patterns, and APAC in camp settings were included in the study. Results described situations of SV in humanitarian settings in Africa as "terrible", "bad", "an epidemic", and "severe" as girls were used as sex objects, for profile enhancement and as a weapon of war. We also found that the illegality of APAC in Africa is causing a high occurrence of clandestine abortions in conflict contexts. Disclosing SV among IDPs in Africa did not follow a clear-cut pattern but was generally determined by socio-demographic characteristics. Sexual health is a fundamental right of all, as enshrined in SDG 3, which makes this topic a major public health issue. We therefore conclude that although disclosure may aggravate stigmatisation in some instances due to adverse reactions, it is still crucial to the healing processes.

Self-Managed Abortion Attempts Before vs After Changes in Federal Abortion Protections in the US

With decreasing access to facility-based abortion in the US, an increase in self-managed abortion (SMA) using various methods is anticipated. To date, no studies have examined changes in SMA in the shifting policy landscape. To estimate changes in SMA prevalence among the general US population from before to after the Supreme Court's June 2022 decision overturning federal abortion protections. Serial cross-sectional surveys were administered throughout the US from December 10, 2021, to January 11, 2022, and June 14 to July 7, 2023. Participants included online panel members assigned female sex at birth, ages 18 to 49 years (or ages 15-17 years if a household member), who were English- or Spanish-speaking. Year of the survey (2021-2022 vs 2023). Participants were asked whether they had "ever taken or done something on their own, without medical assistance, to try to end a pregnancy" and, if so, details of their experience. Changes in the weighted SMA prevalence between survey years were examined, factors associated with SMA experience were identified, and projected lifetime SMA prevalence was calculated using discrete-time event history models, accounting for abortion underreporting. Median age of the participants was 32.5 (IQR, 25-41) years in 2021-2022 (n = 7016) and 32.0 (IQR, 24-40) in 2023 (n = 7148). Across both years, approximately 14% were non-Hispanic Black, 21% were Hispanic, and 54% were non-Hispanic White. The weighted adjusted proportion that ever attempted SMA was 2.4% (95% CI, 1.9%-3.0%) in 2021-2022 and 3.4% (95% CI, 2.8%-4.0%) in 2023-an increase of 1.0% (95% CI, 0.2%-1.7%; P = .03). Projected lifetime SMA prevalence accounting for abortion underreporting was 10.7% (95% CI, 8.6%-12.8%). In adjusted analyses, SMA experience was higher among non-Hispanic Black (4.3%; 95% CI, 2.8%-5.8%) vs other racial and ethnic (2.7%; 95% CI, 2.2%-3.1%) groups (P = .04) and sexual and gender minority (5.0%; 95% CI, 3.4%-6.6%) vs heterosexual or cisgender (2.5%; 95% CI, 2.0%-2.9%) participants (P < .001). Approximately 4 in 10 (45.3% in 2021 and 39.0% in 2023) SMA attempts occurred before age 20 years. The methods used included herbs (29.8% [2021-2022] vs 25.9% [2023]), physical methods (28.6% [2021-2022] vs 29.7% [2023]), or alcohol or other substances (17.9% [2021-2022] vs 18.6% [2023]). Few participants (7.1% [2021-2022] vs 4.7% [2023]) sought emergency care for a complication. In this serial nationally representative survey study, increased SMA was observed following the loss of federal abortion protections. The findings revealed increased SMA use among marginalized groups, most often with ineffective methods. These findings suggest the need to expand access to alternative models of safe and effective abortion care and ensure those seeking health care post-SMA do not face legal risks.

A, Masamba Lived experiences and pathways to unsafe abortion among women and adolescents accessing post abortion care at selected hospitals in Lilongwe, Malawi

A, Masamba Lived experiences and pathways to unsafe abortion among women and adolescents accessing post abortion care at selected hospitals in Lilongwe, Malawi

Women’s experiences of needing abortion care whilst incarcerated: a systematic review of the international literature

Incarcerated women are confined in institutions designed to punish. These sites often ignore the complex mental and physical health needs of people who are incarcerated. Despite the World Health Organization stressing the need for access to reproductive healthcare in carceral institutions, stigma surrounding abortion care and health inequalities create contextually specific issues for incarcerated people seeking to access these services. There is also a dearth of research conducted directly with incarcerated women, trans men and non-binary people to examine their experiences of abortion. A systematic review of international peer-reviewed and grey literature was completed to summarise existing evidence from research conducted on the experiences of needing abortion care whilst incarcerated. Various experiences were identified including: conditions of confinement shaping abortion decisions; bureaucratic obstacles to accessing abortion services; incarcerated women, carceral staff and carceral healthcare staff’s lack of understanding of abortion rights and procedures; and a scarcity of support and empathy, including experiences of stigmatisation and lack of confidentiality. There exists a significant gap in research examining the experiences of incarcerated people who may need an abortion, emphasising the need for international collaboration and advocacy to address systemic issues that extend beyond local contexts.

Medication and procedural abortion uptake during a period of increasing abortion hostility

Hundreds of state-level abortion restrictions were implemented in the US between 2010 and 2020. Medication abortion was being widely adopted during this same period. Understanding the impact of health policies and political climate will improve the delivery of and access to reproductive healthcare in a period of rapid change. To measure the association between state abortion hostility and mifepristone and procedural abortion rates, we conducted a state-level repeated cross-sectional study using 2010–2020 employer-sponsored insurance claims data from Merative MarketScan. The exposure of interest was a 13-point state-level abortion hostility score based on the presence of policies which either reduce or protect access to abortion. Outcomes of interest were annual mifepristone and procedural abortion claims per 100,000 enrollees. We used a linear mixed model adjusting for urbanicity, age group, and year. We assessed whether temporal trends in abortion claims were modified by state abortion hostility by interacting year with two measurements of abortion hostility: baseline score in 2010 and change from baseline score. We found that median state-level mifepristone claims increased from 20 to 37 per 100,000 included enrollees; meanwhile, median procedural abortions claims decreased from 69 to 20 per 100. For mifepristone, every unit increase in a state's baseline abortion hostility score was associated with 7.5 (CI, −12 to −3.6) fewer mifepristone claims per 100,000 in 2010. For states with baseline hostility and change scores of zero, we did not observe a significant time trend over the 11 year study period. For every unit increase in baseline hostility, the time trend changed by 0.5 fewer claims (CI, −0.8 to −0.2) per 100,000 per year. States with higher baseline abortion hostility had fewer overall abortions, less uptake of mifepristone abortions, and slower decline in procedural abortions between 2010 and 2020. Changes in hostility from new restrictions during this time period did not significantly impact claims. Advocates for abortion access must simultaneously attend to individual abortion policies and the overall political climate. Updated research on the relationship between political climate and the evolving clinical landscape of abortion care is needed to inform this work.

Adolescent reproductive health in a post- Dobbs landscape: a review.

To summarize notable recent research in adolescent reproductive health, particularly with respect to a rapidly changing legal landscape surrounding health services that significantly impact adolescent health. Approval of the first over-the-counter contraceptive pill represented a major advance in adolescent reproductive health, which relied on research regarding its safety, efficacy, and potential to increase access for vulnerable groups. Despite this approval, disparities persist in equitable contraceptive access for adolescents of color and those from sexual and gender identity minorities. Legal changes in access to abortion care and parental involvement in reproductive health decision-making have presented significant challenges for young people across the U.S. Recent research points to the promise of telehealth abortion care and parental acceptance of confidentiality in adolescent reproductive healthcare. Misinformation remains a barrier to advancing adolescent reproductive health and points to continued opportunities for providers to create evidence-based online content. In this review, we discuss recent research regarding adolescent reproductive health and laws impacting the reproductive health of adolescents. As the legal landscape evolves, further research surrounding the effect of policy changes that both expand and restrict access to adolescent reproductive health services will be critical to advancing adolescent health.

Strengthening the Provision of Abortion and Sexual and Reproductive Health Care Post-Dobbs: An Initiative of the Philadelphia Department of Public Health

The U.S. Supreme Court decision on Dobbs v. Jackson Women’s Health has had a disruptive impact on not only the patients who seek reproductive health care, abortion care providers, and abortion care–adjacent organizations, but has also sparked a need for public health departments to take on new roles to support their communities. In the wake of that 2022 decision, the Philadelphia Department of Public Health launched an ongoing initiative to increase support for the provision of abortion and sexual and reproductive health care. The authors describe the effort, which started with a landscape analysis and qualitative interview analysis to understand the needs and concerns of those comprising the abortion care delivery system in Philadelphia. The authors found that the immediate, short-term needs to support the local abortion care delivery network included funding for patients seeking abortion care, plus communication and education to counter misinformation about the legality of abortion in Pennsylvania. Through the initiative’s research efforts, the authors also found that long-term needs included care capacity–building and health systems–strengthening by removing non–evidence-based restrictions on abortion access and care. Another ongoing role for public health systems is to address and avert legislative or regulatory efforts to impose restrictions to Medicaid coverage for abortion services or other impediments that would disrupt the ability or capacity of health care providers to deliver comprehensive reproductive care. Today, public health departments are uniquely suited to address and mitigate the emerging post-Dobbs chilling effect on both patients and clinicians who may fear legal, professional, or personal consequences as they navigate options for appropriate, evidence-based reproductive health care, even in states where abortion remains legal.

How to Bridge Public Health and Care Delivery

This special theme issue of NEJM Catalyst Innovations in Care Delivery, guest edited by Nicholas Stine, MD, includes articles, case studies, and research reports on coordination across public health and care delivery, Covid-19 response, tuberculosis screening, the 2022 mpox outbreak, pediatric asthma intervention, abortion and reproductive health care, and public health data.

Towards a rights-based approach for disabled women's access to abortion.

This article adds to the still limited scholarship on the impact of abortion laws and policies on people with disabilities and those with diminished capacity who seek abortion. We argue that neither the legal nor policy framework currently operating in England and Wales adequately incorporates and protects the rights of people with disabilities or those experiencing mental ill-health. Rather, the law and policy framework jeopardizes their reproductive agency. We argue that greater attention to and incorporation of standards contained within the UN Convention on the Rights of Persons with Disabilities (including the sources produced by its Committee) and implementation of guidelines produced by the World Health Organization would result in a rights-affirming framework that supports disabled women's reproductive agency, enhances their effective enjoyment of human rights, and supports them in accessing quality abortion care.

Lifetime abortion incidence when abortion care is covered by Medicaid: Maryland versus five comparison states.

To estimate the association of Medicaid coverage of abortion care with cumulative lifetime abortion incidence among women insured by Medicaid. We use 2016-2019 (Pre-Dobbs) data from the Survey of Women studies that represent women aged 18-44 living in six U.S. states. One state, Maryland, has a Medicaid program that has long covered the cost of abortion care. The other five states, Alabama, Delaware, Iowa, Ohio, and South Carolina, have Medicaid programs that do not cover the cost of abortion care. Our sample includes 8972 women residing in the study states. Our outcome, cumulative lifetime abortion incidence, is identified using an indirect survey method, the double list experiment. We use a multivariate regression of cumulative lifetime abortion on variables including whether women were Medicaid-insured and whether they were residing in Maryland versus in one of the other five states. This study used secondary survey data. We estimate that Medicaid coverage of abortion care in Maryland is associated with a 37.0 percentage-point (95% CI: 12.3-61.4) higher cumulative lifetime abortion incidence among Medicaid-insured women relative to women not insured by Medicaid compared with those differences by insurance status in states whose Medicaid programs do not cover the cost of abortion care. We found that Medicaid coverage of abortion care is associated with a much higher lifetime incidence of abortion among individuals insured by Medicaid. We infer that Medicaid coverage of abortion care costs may have a very large impact on the accessibility of abortion care for low-income women.

Experiences of the Irish model of community medical abortion: adherence to self-managed, people-centred abortion care

ABSTRACT The Irish abortion model of care, implemented in January 2019, is distinctive for being located primarily in the community and relying principally on medical abortion outside a clinical setting. The model facilitated mapping onto existing healthcare structures and thereby allowed abortion provision to commence quickly after Repeal of the 8th Amendment. This article considers the operation of the Irish model of abortion care under 12 weeks gestation which has been characterised as a community medical abortion model. It draws on data gathered through 46 in-depth interviews with people accessing abortion care under twelve weeks gestation between December 2019 and April 2021. These qualitative accounts of experiences of first-trimester abortion care portray what the Irish model of care entails in practice from the abortion seeker perspective. The community model of medical abortion is portrayed as involving a hybrid of self-managing abortion outside of clinical settings in the context of legally regulated provision of medication delivered through a network of community-based primary care doctors. The Irish model of care anticipated a significant shift in how self-management of medical abortion is viewed by the World Health Organization whose 2022 updated abortion guidelines included self-management of medical abortion for the first time as a fully recommended model of abortion care. The paper considers how the Irish model of community medical abortion relates to self-managed and people-centred abortion care and whether this hybrid model facilitates or circumscribes these features.

Scoping review of qualitative studies on family planning in Uganda.

Family planning (FP) is an essential component of public health programs and significantly impacts maternal and child health outcomes. In Uganda, there is a need for a comprehensive review of the existing literature on FP to inform future research and programmatic efforts. This scoping review aims to identify factors shaping the use of FP in Uganda. We conducted a systematic search of eight scholarly databases, for qualitative studies on FP in Uganda. We screened the titles and abstracts of identified articles published between 2002-2023 and assessed their eligibility based on predefined criteria. We extracted data from the 71 eligible studies and synthesized the findings using thematic analysis and the Ecological Systems Theory (EST) individual, interpersonal, community, institutional, and policy-level determinants. Findings reveal the interplay of factors at different socio-ecological levels influencing family planning decisions. At the individual level, the most common determinants related to the EST were knowledge and attitudes of FP. Interpersonal dynamics, including partner communication and social support networks, played pivotal roles. Community-level factors, such as cultural norms and accessibility of services, significantly influenced family planning practices. Institutional and policy-level factors, particularly a healthcare system's quality and policies, also shaped use. Other themes included the intersection of HIV/AIDS on FP practice and Ugandan views of comprehensive abortion care. This scoping review underscores the intricate socio-ecological fabric shaping FP in Uganda. The findings highlight the need for targeted interventions to increase knowledge and awareness of FP, improve access to services, and address social and cultural norms that discourage contraceptive use. Policymakers and program implementers should also consider gender dynamics and power imbalances in FP programs to ensure they are equitable and effective.

A nurse-led model of care to improve access to contraception and abortion in rural general practice: Co-design with consumers and providers.

To describe key features of a co-designed nurse-led model of care intended to improve access to early medication abortion and long-acting reversible contraception in rural Australian general practice. Co-design methodology informed by the Experience-Based Co-Design Framework. Consumers, nurses, physicians and key women's health stakeholders participated in a co-design workshop focused on the patient journey in seeking contraception or abortion care. Data generated at the workshop were analysed using Braun and Clarkes' six-step process for thematic analysis. Fifty-two participants took part in the co-design workshop. Key recommendations regarding setting up the model included: raising awareness of the early medication abortion and contraceptive implant services, providing flexible booking options, ensuring appointment availability, providing training for reception staff and fostering good relationships with relevant local services. Recommendations for implementing the model were also identified, including the provision of accessible information, patient-approved communication processes that ensure privacy and safety, establishing roles and responsibilities, supporting consumer autonomy and having clear pathways for referrals and complications. Our approach to experience-based co-design ensured that consumer experiences, values and priorities, together with practitioner insights, were central to the development of a nurse-led model of care. The co-designed nurse-led model of care for contraception and medication abortion is one strategy to increase access to these essential reproductive health services, particularly in rural areas, while providing an opportunity for nurses to work to their full scope of practice. Nurse-led care has gained global recognition as an effective strategy to promote equitable access to sexual and reproductive healthcare. Still, nurse-led contraception and abortion have yet to be implemented andevaluated in Australian general practice. This study will inform the model of care to be implemented and evaluated as part of the ORIENT trial to be completed in 2025. Reported in line with the Standards for Reporting Qualitative Research (SRQR) checklist. Two consumer representatives contributed to the development of the co-design methodology as members of the ORIENT Intervention Advisory Group Governance Committee.

Characteristics of foreign-born abortion patients in the United States, 2021–2022

ObjectivesThis study aimed to examine the characteristics of foreign-born abortion patients compared to those born in the Unites States and to explore whether barriers for foreign-born patients varied by state Medicaid coverage of abortion care. Study designWe used data from the Guttmacher Institute’s 2021–2022 Abortion Patient Survey, a national sample of patients obtaining clinic-based abortion care in the United States. We compared sociodemographic characteristics of foreign- and US born respondents, as well as barriers to care. Among foreign-born patients, we compared those in Medicaid coverage states vs states that restrict Medicaid coverage. ResultsSome 12% of the 6429 respondents were born outside the United States. Compared to US born patients, they were less likely to have Medicaid coverage and more likely to be Asian/Native Hawaiian/Pacific Islander or Hispanic, to have no health insurance, and to have completed the survey in Spanish. In addition, foreign-born patients were more likely to report delays because they did not know where to get an abortion (18.3% vs. 12.6% for US born). Compared to foreign-born patients living in Medicaid coverage states, those in non-Medicaid states reported multiple barriers, particularly related to cost: respondents in non-Medicaid states were three times as likely to pay out of pocket for abortion (75.8% vs 27.4%) and five times more likely to rely on financial assistance (24.1% vs 4.8%). ConclusionsForeign-born abortion patients face knowledge and financial barriers to accessing abortion care compared to those who are US born, and these financial burdens are amplified for those living in non-Medicaid coverage states. ImplicationsAbortion patients born outside the United States may have overcome many obstacles to obtain care. Expanding state Medicaid coverage of abortion could reduce cost burdens for foreign-born populations.