Abortion Clinics Research Articles

Experiences with small and large numbers of protesters at abortion clinics in North Carolina

ObjectivesTo analyze the association between number of antiabortion protesters and patients’ and their companions’ experiences accessing abortion clinics in North Carolina. Study designIn this concurrent mixed-methods study conducted in 2018–2019 at two independent abortion clinics in North Carolina, the author triangulated the methods of participant observation, descriptive statistical analysis of survey data, and thematic content analysis of open-ended responses to compare experiences of respondents who observed larger (>10) versus smaller (1–10) numbers of protesters at their clinic visit. The analytic sample contained experiences of patients and companions who saw protesters during the study period. ResultsOf 1530 people approached for the survey, 886 (58%) completed the questionnaire. Overall, 655 respondents were included in the analysis. Most respondents (n = 546, 83%) saw 1 to 10 protesters, versus those who saw >10 protesters (n = 109, 17%). Respondents who saw 1 to 10 protesters had their cars stopped at higher rates (53%) than those who saw >10 protesters (40%) but reported being physically approached at similar rates (22% vs. 23%). Respondents who saw >10 protesters indicated that it was more dangerous to drive into the clinic (44% vs. 23%) and more difficult to access the clinic (65% vs. 39%), when compared with people who saw 1 to 10 protesters. Respondents who saw >10 protesters also reported that they thought about leaving more frequently (21% vs. 12%), that the protesters made them feel unsafe (44% vs. 23%), made their visit more stressful (71% vs. 59%), and protesters negatively impacted their clinic experience at higher rates (47% vs. 31%). ConclusionsRespondents experienced logistical barriers to clinic access regardless of the number of protesters, though these worsened with larger numbers of protesters. Respondents perceived larger numbers of protesters as more intimidating and felt less safe navigating into the clinic. While all respondents made it to their appointments, these perceptions about larger numbers show how clinic protesting is an intimidating force that interferes with clinic access. ImplicationsShowing the ways that the number of protesters relates to logistical and emotional barriers can help clinics in planning mitigation measures to address issues of clinic access for their patients and their companions.

The role of paediatrics in the abortion debate.

The role of paediatrics in the abortion debate.

Why women choose self-managed telemedicine abortion in the Netherlands during the COVID-19 pandemic: a national mixed methods study

BackgroundThe COVID-19 pandemic has imposed strict lockdown restrictions that have introduced barriers to in-person abortion clinic visits in the Netherlands. Women on Web (WoW) is a global medical abortion telemedicine...

Abortion incidence and service availability in the United States, 2020.

This study provides a baseline assessment of abortion incidence and service delivery prior to Roe v. Wade being overturned. We collected information from all facilities known to have provided abortion services in the United States in 2019 and 2020. We examined abortion incidence by state, region and nationally and combined data on number of abortions with population data to estimate abortion rates. We also examined the number of abortion clinics, trends in medication abortion and service disruptions and changes in abortion protocols that occurred during the COVID-19 pandemic. We compare these findings to those of our prior Abortion Provider Census, which collected information for 2017. We documented 930,160 abortions in 2020, an 8% increase from 2017. Between 2017 and 2020, abortion incidence increased in all four regions of the country and in a majority of states. The total number of clinics providing abortion care remained stable nationally but increased in the Midwest and the West and declined in the Northeast and South. There were 492,210 medication abortions in 2020, a 45% increase from 2017. A substantial minority of clinics adjusted protocols in response to COVID, most commonly adopting remote pre- and post-abortion counseling. This study did not address factors behind the increase in abortion. However, this report demonstrates that the need for abortion care was growing just prior to the overturning Roe v. Wade, and the impact of this decision will be even more far-reaching than previously expected.

P014Evaluating abortion cash-pay availability during the early covid-19 pandemic: Data from a nationwide survey of abortion providers

<h3>Objectives</h3> Pregnant people seeking abortion may require access to cash-pay services, and little is known about cash-pay availability for abortion services among US abortion clinics. We examined differences in cash-pay options between hospital-affiliated clinics and non-hospital-affiliated clinics (independent or Planned Parenthood clinics). <h3>Methods</h3> We analyzed data from the second phase of a longitudinal nationwide survey of abortion providers conducted by the Society of Family Planning (collected May–July 2020). We compared cash-pay options for medication abortion, first-trimester surgical/procedural abortion, and dilation and evacuation offered by hospital-affiliated and non-hospital-affiliated clinics. <h3>Results</h3> Sixty-two clinics completed the survey (31 hospital-affiliated and 31 non-hospital-affiliated). We found that 85% of all clinics offered a cash-pay option for medication abortion, 86% for first-trimester abortion, and 78% for dilation and evacuation. We found that hospital-affiliated clinics were significantly less likely to report serving out-of-state patients (p<0.01), first-trimester surgical/procedural abortion (75% vs. 97%, p=0.02), and dilation and evacuation (62% vs. 100%, p<0.01). <h3>Conclusions</h3> Though a majority of all clinics surveyed offered cash-pay options for abortion, hospital-affiliated clinics were less likely to offer cash-pay options for abortion procedures. Given concerns regarding future abortion access, it will be important to expand availability of cash-pay options for abortion in all settings. From our data, hospital-affiliated clinics have the most room to improve on this front.

P016Experiences of self-managed abortion in indiana: Financial barriers to clinical care and a need for information on self-managed medication abortion

<h3>Objectives</h3> We aimed to understand Indiana residents' experiences and preferences regarding self-managed abortion in a highly restrictive state. <h3>Methods</h3> Between June 2021 and April 2022, we recruited pregnant people who lived in Indiana and were considering abortion through Google advertisements, online posts, abortion clinics, and abortion funds. Respondents completed a self-administered online survey at baseline and a second survey one month later. We analyzed reported self-managed abortion experiences at baseline and endline, and characteristics of those who self-managed an abortion. <h3>Results</h3> Among 370 baseline respondents, 66 (18%) reported a preference for self-managed medication abortion over clinical care, while 33 (9%) participants reported an actual attempt to self-manage an abortion for the current pregnancy, and an additional four (1%) were in the process of self-managing. Most who self-managed identified as White (58%), 33% as Black, and 6% as Asian; and were aged 16–37, with pregnancies from 4 to 13 weeks' gestation. Sixteen (49%) respondents used herbs, six (18%) used misoprostol and/or mifepristone, six (18%) used other medications, two (6%) took emergency contraception after confirming the pregnancy, and 12 (37%) used other methods (eg, caffeine, physical exertion). At endline, 13 (3%) respondents reported ending their pregnancy using self-managed medication abortion. The most common reason given for self-managing an abortion was the inability to pay for clinical care. <h3>Conclusions</h3> Indiana residents need financial support to access clinical abortion care when that is their preference, and need information on safe, effective methods of self-managed medication abortion as an option, particularly in light of anticipated further restrictions on abortion access in the coming year.

P017Experiences of indiana residents who traveled out of state to obtain abortion care: The role of abortion funds in restrictive states

<h3>Objectives</h3> Given Indiana's highly restrictive policy context with regard to abortion, and anticipated increases in restrictions, we aimed to measure residents' experiences traveling out of state for abortion care. <h3>Methods</h3> Between June 2021 and April 2022, we recruited pregnant people who lived in Indiana and were considering abortion through Google advertisements, abortion clinics, and abortion funds. Respondents completed a self-administered online survey at baseline and a second survey one month later. We analyzed characteristics and experiences of those who reported leaving the state to obtain abortion care. <h3>Results</h3> Among 213 participants who reported an abortion at endline, 56 (26%) left the state to obtain abortion care. These travelers were aged 15–39 with pregnancies from 6 to 31 weeks' gestation, 71% were parents; and 25 (45%) identified as Black, 23 (41%) as White, and five (9%) as multi-racial. Participants traveled to Illinois most commonly (70%), followed by Kentucky (12%), Ohio (4%), and two other states. The most common barriers experienced by travelers included gathering money (68%), traveling a long distance to the clinic (27%), taking time off (23%), not knowing where to go (21%), arranging childcare (20%), and having difficulty complying with waiting periods and gestational restrictions, and facing clinic protestors. Facilitators included financial support from an abortion fund (63%), easily accessible online information (43%), and financial support from a clinic-based abortion fund (30%). <h3>Conclusions</h3> As more Indiana residents are forced to leave the state for abortion care, investing in abortion funds and practical support services will be essential strategies for maintaining access to abortion care across state lines.

P089Rh-immunoglobulin administration for patients with first-trimester bleeding: Estimating the cost to the healthcare system

<h3>Objectives</h3> Administration of Rh-immunoglobulin remains standard practice in many settings in the US despite lack of evidence supporting clinical benefit. We sought to estimate the cost of this practice to both freestanding clinics and academic abortion care settings. <h3>Methods</h3> Time-driven activity-based costing was used to analyze tasks associated with blood typing and Rh-immunoglobulin administration, when indicated, for all patients with first-trimester bleeding at a large academic family planning center. Tasks were also reviewed at two freestanding abortion clinics. Process maps were created for each setting, and costs for Rh-positive and Rh-negative patients were estimated. <h3>Results</h3> At the freestanding abortion clinics, which used finger sticks to type patients, per-patient costs were $46.60 if Rh-positive and $205.18 if Rh-negative. At the academic institution, per-patient costs were $78.55 if Rh-positive and $210.27 if Rh-negative for patients with a documented historical blood type. Costs were $172.01 if Rh-positive and $362.19 if Rh-negative for patients requiring phlebotomy due to lack of documented blood type. Total monthly clinic costs associated with blood typing and Rh-immunoglobulin administration in the first trimester ranged from $11,131.69 in the lower-volume academic setting to $49,514.21 in the freestanding clinic with the highest patient volume. <h3>Conclusions</h3> Blood typing and Rh-immunoglobulin cost up to half a million dollars annually per clinic, with even Rh-positive patients with a previously documented blood type contributing significant costs. These time-based costing results highlight the burden of this practice to the healthcare system and provide an argument for reassessing the value of Rh-immunoglobulin administration in the first trimester.

O07The impact of the texas abortion ban on gestational age at time of abortion in a large-volume colorado clinic

<h3>Objectives</h3> To assess changes in the proportion of Texas residents, gestational age at time of abortion, and rates of second-trimester abortion, at a university-affiliated abortion clinic in Colorado after Texas passed Senate Bill 8 (SB8), which prohibits abortions >6 weeks' gestation. <h3>Methods</h3> We focused on all patients obtaining an abortion ≤22 weeks' gestation at a university-affiliated clinic between January 2018 and mid-April 2022. We created two time periods: before SB8 (January 2018–August 2021) and after SB8 (September 2021–April 2022). We compared the proportion of Texas residents obtaining care and gestational age categories before and after SB8 using chi-square tests. We determined the adjusted odds of a second-trimester abortion (≥13 weeks) after SB8 using logistic regression models adjusted for gravida, parity, age, and the proportion of Texas residents. <h3>Results</h3> We assessed 4,358 abortions; 3,630 before and 728 after SB8. After SB8, the proportion of patients who were Texas residents increased from 1% to 17%, p<0.001. Among all patients, abortions ≥15 weeks increased from 11% to 21%, p<0.01, and surgical abortions at 6–10 weeks decreased from 46% to 33%, p<0.001. There was no change in abortions at 11–14 weeks. The proportion of second-trimester abortions increased from 17% to 27%, p<0.001 and the odds nearly doubled after SB8 (aOR1.9, 95% CI, 1.6–2.3). Although higher among Texas residents (aOR, 2.6, 95% CI,1.1–6.9), the odds of a second-trimester abortion also increased among Colorado residents (aOR,1.8, 95% CI, 1.4–2.2). <h3>Conclusions</h3> Post-<i>Roe</i> abortion bans will likely delay care not only for people forced to seek care out of state, but for residents of states maintaining abortion access.

O20Trauma responsive abortion care (on trac study): The abortion experiences of patients with a history of trauma

<h3>Objectives</h3> Due to intersectional structural inequities, individuals seeking abortion have experienced disproportionately high rates of trauma. We sought to elicit patient perspectives on how prior trauma(s) influenced their abortion experiences. <h3>Methods</h3> We recruited individuals from Chicago-area abortion clinics to participate in semi-structured interviews exploring how prior trauma(s) influenced their abortion experience and how interactions with providers/staff ameliorate or worsen the impact of past trauma(s). Participants were aged 18 or older, had experienced an abortion and self-identified a history of trauma (sexual assault, domestic violence, or adverse childhood experience). We used modified grounded theory to identify salient themes. <h3>Results</h3> We conducted 30 interviews, identifying trauma-activating factors and trauma-responsive strategies before, during, and after obtaining the abortion. Participants reported that, pre-abortion, restricted access and a lack of procedure options activated trauma-related feelings of autonomy loss and that they desired unbiased information, particularly from peers. Participants described how physical pain/discomfort and provider/staff use of inappropriate language during procedures worsened their experience; while use of neutral language, warnings prior to touch, proper draping, and constant checking-in and offering options helped mitigate effects of prior trauma(s). Post-procedurally, participants desired mental health support specifically addressing stigma, though this resource was rarely available. <h3>Conclusions</h3> Applying key tenets of trauma-responsive care to all patients seeking abortion mitigates impacts of prior traumas on the abortion experience. Providers can resist re-traumatization on a clinical level via the use of language, bi-directional communication, and by offering options, including pain management and behavioral support. On a systemic level, providers can advocate for increased abortion access and address stigma.

“They're forcing people to have children that they can't afford”: a qualitative study of social support and capital among individuals receiving an abortion in Georgia

Abortion is common but highly stigmatized in the United States, and the overturning of Roe v. Wade severely restricted abortion access in many states across the nation. Data reveal that maternal morbidity and mortality are already increasing, and research suggests existing inequities in abortion access across racial/ethnic and socioeconomic groups will be exacerbated. Research has shown that social support (perceived and received aid from one's social network) and social capital (resources accessed through those social connections) can improve access to health services and decrease barriers to care. Given the escalating barriers to abortion, including longer travel distances, it is imperative to better understand the roles of social support and social capital within abortion access, especially for people living on lower incomes and people of color. Our team conducted in-depth interviews with post-abortion patients (n = 18) from an urban abortion clinic in Georgia in 2019 and 2020, shortly after a six-week gestational age abortion limit had been passed but before it was enacted. We examined how people described their social support and social capital – or lack thereof – when making decisions about their pregnancy and their ability to access abortion. We found that social support and social capital – economic support in particular – were key facilitators of both abortion access and parenting, but participants often experienced barriers to economic support within their social networks due to poverty, unstable partnerships, structural inequality, and abortion stigma. Women experienced constraints to their reproductive autonomy, wherein they had no alternatives but abortion. Our findings suggest that increased economic support and de-stigmatization of abortion are needed to improve reproductive autonomy. Our findings also indicate that restricting and outlawing abortion services is significantly detrimental to the well-being of pregnant people, their families and networks, and their communities by perpetuating cycles of poverty and deepening socioeconomic and racial/ethnic inequities.

P051Understanding medication abortion denial among a cohort of abortion clinic patients in southern california

<h3>Objectives</h3> Medication abortion is safe and effective up to 77 days' gestation. It is unknown how often patients who present for medication abortion do not receive one and whether those who are ineligible for medication abortion eventually receive surgical abortion. <h3>Methods</h3> We performed a retrospective cohort study of patients presenting for medication abortion at medication-abortion-only Planned Parenthood of the Pacific Southwest (PPPSW) sites from January to December 2021. PPPSW has 15 such clinics and two that offer surgical abortion. Patients seen at a medication-abortion-only site who were found ineligible after intake ultrasound (>70 days' gestation) were scheduled for an abortion at a surgical location. Electronic medical records were reviewed to determine medication abortion outcomes. <h3>Results</h3> Of 11,684 patients presenting for medication abortion at sites that only offered this service, 2,224 (19%) did not receive a medication abortion: 1,251 (56%) had an intrauterine pregnancy (IUP), 388 (17%) had a pregnancy of unknown location (PUL), and 116 (5%) had a non-viable pregnancy. Among those with an IUP, 426 (34%) presented at >70 days' gestation by ultrasound, and 223 (18%) between 71–77 days' gestation. Of these patients, 324 (76%) went on to receive a surgical abortion (54% dilation and curettage and 22% dilation and evacuation) after an average wait time of 10.5 days. <h3>Conclusions</h3> Even with a referral system in place, one-quarter of those presenting for medication abortion with an IUP at >70 days' gestation were lost to follow-up. Despite safety of medication abortion for patients with PUL, many of these patients did not receive one. Expanding medication abortion eligibility criteria by one week to 77 days' gestation and allowing medication abortion for PUL would expand access.

P034Who fails to obtain abortion care in indiana? Results from a longitudinal online survey

<h3>Objectives</h3> We aimed to measure barriers to accessing abortion care in Indiana, a state with hostile abortion policies that is anticipated to become even more restrictive. <h3>Methods</h3> Between June 2021 and April 2022, we recruited pregnant Indiana residents seeking abortion via Google advertisements and other online posts, as well as through abortion clinic waiting rooms and callers to local abortion funds. Participants completed a self-administered, online survey at baseline, and a follow-up survey approximately one month later to ascertain outcomes. We compared the proportion of people who reported an abortion at endline by recruitment method and social and economic barriers experienced, using chi-square tests of independence and multivariable logistic regression models. <h3>Results</h3> Overall, 351 participants completed the baseline survey and 205 (58%) participants completed endline. Among those recruited from Google ads, 46% had an abortion compared to 91% and 94% of participants recruited from an abortion fund or a clinic (p<0.01). Participants who reported experiencing abortion stigma — specifically, their family opposed abortion or they feared clinic protestors — (76% vs. 87%), who did not have paid jobs (76% vs. 88%), and were uninsured (65% vs. 86%) were less likely to have received an abortion than were those who did not report these experiences. <h3>Conclusions</h3> Anti-abortion sentiment and financial barriers prevented people from obtaining abortion care in Indiana, while abortion funds facilitated access. As abortion becomes increasingly restricted and likely clinically inaccessible in Indiana, facilitating connections to abortion funds and combating abortion stigma are critical strategies to ensure access to care.

P023Adaptations to covid: Analysis of national abortion clinic survey data

<h3>Objectives</h3> To analyze changes in national abortion clinic practices and telehealth utilization during the COVID-19 pandemic. <h3>Methods</h3> We conducted descriptive analyses of nationwide abortion service trends utilizing a longitudinal survey distributed by the Society of Family Planning. The dataset comprised three surveys: T1 (February–March 2020), T2 (May–July 2020), and T3 (August–October 2020). Demographic characteristics including region (Northeast, Midwest, South, Midwest, and West) and type of clinic site (academic/hospital-affiliated, Planned Parenthood, and independent) were provided in the survey data. Wilcoxon rank sum and Kruskal-Wallis tests were utilized for statistical analysis. <h3>Results</h3> There was no difference in the volume of abortion services provided nationwide over T1–T3. However, there was a significant increase in the proportion of medical abortions compared to procedural abortions from T1 to T3 (26.7% to 40.0%, p<0.05). Planned Parenthood/independent sites performed a significantly greater proportion of medication abortions than academic/hospital-affiliated clinic sites (p<0.05) across all three time periods. There was no difference in utilization of telehealth across the time periods, even when controlling for type of site and region. Sites offering telehealth services did not experience changes in volume of abortions or in distribution of abortion services provided (medication vs. procedural). <h3>Conclusions</h3> An increase in the proportion of medication abortions compared with procedural abortions may suggest increasing access to medication abortion as clinics adapted to limitations of the COVID-19 pandemic. Utilization of telehealth did not appear to decrease the availability of operative procedures or volume of services, suggesting that telemedicine is a favorable care delivery option for clinics hoping to limit face-to-face interaction as the pandemic continues.

P033Patient acceptability of asynchronous vs synchronous telehealth medication abortion care in the US

<h3>Objectives</h3> Despite its recent expansion in the US, little is known about patient experiences with direct-to-patient telehealth abortion care and its role in addressing inequities in access to care. <h3>Methods</h3> We analyzed surveys from patients of three US virtual abortion clinics — Choix, Hey Jane, and Abortion on Demand — who received care between April 2021 and January 2022. We described telehealth abortion experiences and used logistic regression to evaluate inequities by race/ethnicity and by whether the patient communicated with the provider by video (synchronous) or messaging (asynchronous). <h3>Results</h3> Across the 1,306 included participants, nearly all (98%) felt they could trust the telehealth provider, 95% said that telehealth abortion was the right experience for them, and 89% were very satisfied. Participants cited privacy (93%) and the ability to get the abortion pills quickly (91%) as benefits. The most common drawbacks were concerns about whether the service was legitimate (37%), not confirming the abortion outcome at a clinic (23%), and not having a screening ultrasound (21%). Compared to white participants, Asian participants were less likely to be very satisfied with their care (OR, 0.5; 95% CI, 0.3–1.0). We found no other differences by race/ethnicity. While patients who received synchronous care were more likely to report that telehealth was right for them (OR, 2.6; 95% CI, 1.0–6.3), we found no differences in satisfaction and trust by communication method. <h3>Conclusions</h3> Telehealth abortion care is highly acceptable, and its benefits include privacy and expediency. However, there may be some differences by race/ethnicity that warrant further exploration.

Traveling to California from out of state to receive abortion services at a hospital-based clinic: A qualitative study of people’s experiences

ObjectivePeople seeking abortion care in the Western United States face unique challenges. We conducted a qualitative study among people who traveled to California from out of state to receive abortion services, with the aim of characterizing the interplay of motivators, costs, and facilitators to accessing abortion in this region. MethodsWe recruited English-speaking people residing outside of California who accessed care at an urban abortion clinic in San Francisco between October 2017 and May 2018. Interested participants completed a brief demographic survey and in depth semi-structured telephone interview. We relied on grounded theory methods to perform thematic analysis and stopped recruitment upon reaching thematic saturation. ResultsWe conducted 18 in-depth interviews. People mostly had to travel to California for abortion due to local clinic gestational age limits, medical necessity, and to reduce cost. Participants also lamented that travel necessitated unwanted disclosure of their abortion, however this disclosure enabled them to get the logistical support needed for travel. People mostly relied on their networks of family and friends to facilitate these logistics. ConclusionsThis study highlights the interplay of motivators, costs, and facilitators people who travel to California from nearby states face when seeking abortion services. ImplicationsWe position the concept of ‘unwanted disclosure’ as both an emotional cost and an operator that often served to enable people to get the support (logistical, financial, professional) they needed to actualize their abortion in California. These people may benefit from additional financial and social support services in order to actualize their abortion.

Nevertheless, They Persisted: How Patterns of Opposition and Support Shaped the Survival of U.S. Abortion Clinics

AbstractStigmatized organizations are generally assumed to face a variety of unique operational challenges. This paper examines the survival of stigmatized organizations in light of such challenges. Specifically, we investigate how patterns of opposition and support from multiple external stakeholders and audiences affect organizational survival within the context of abortion provision in the United States. We use a fuzzy‐set qualitative comparative analysis (fsQCA) to examine the causal linkages between the above factors and the survival outcomes of the full identifiable industry of 983 abortion clinics that were in operation in the U.S. between 2011 and 2017. Our results reveal the existence of multiple paths to survival, based primarily on either the absence of overt opposition or the presence of factors like political support that enabled organizations to overcome other threats to survival. Our findings show how socio‐political factors affect the survival of organizations in stigmatized industries.

Bottom-up advocacy strategies to abortion access during the COVID-19 pandemic: Lessons learned towards reproductive justice in Brazil.

In Brazil, abortion is only allowed in cases of rape, serious risk to a woman's life or fetal anecephaly. Legal abortion services cover less than 4% of the Brazilian territory and only 1,800 procedures are performed, in average, per year. During the COVID-19 pandemic, almost half of the already few Brazilian abortion clinics shut down and women had to travel even longer distances, reaching abortion services at later gestational ages. In this paper, we describe three bottom-up advocacy strategies that emerged from difficulties deepened during the COVID-19 pandemic at a single abortion service in Brazil, amidst anti-gender policies from the federal government. Telemedicine abortion, outpatient surgical abortion and the provision of abortion after 20 weeks' gestation are important strategies that may reduce inequalities that impact the most vulnerable populations, such as black and indigenous women, children, adolescents and women experiencing domestic violence.

Prevalence of Third-Party Tracking on Abortion Clinic Web Pages

This cross-sectional study assesses how often third-party domains use tracking data from visitors to abortion clinic web pages.

Early pregnancy confirmation availability at crisis pregnancy centers and abortion facilities in the United States

ObjectivesCrisis pregnancy centers (CPCs) seek to dissuade people from having abortions. Twenty-five states have policies supporting CPCs. We aimed: (1) to characterize access to early pregnancy confirmation at CPCs compared to abortion facilities nationwide and (2) to understand the role of state CPC policy in service access. Study designWe conducted a national mystery caller study of 445 CPCs and geographically paired abortion facilities, posing as patients seeking pregnancy confirmation. Facility type (CPC vs abortion facility) was the primary exposure in Aim 1. Wait time to first available early pregnancy appointment was the primary outcome. In Aim 2, state-level CPC policy designation (supportive vs not supportive of CPCs) was the primary exposure. Difference in wait time ≥7 days to first available appointment between CPCs and paired abortion facilities was the primary outcome. ResultsCPCs were more likely than abortion facilities to provide same-day appointments (68.5% vs 37.2%, p < 0.0001), and free pregnancy testing (98.0% vs 16.6%, p < 0.0001). The median wait to first available appointment at a CPC was 0 days (IQR 0,1), compared to 1 day at abortion facilities (IQR 0, 5), p < 0.0001.In states with supportive CPC policy environments, abortion facilities were less likely to have wait times exceeding their paired CPC by a week or more, compared to paired facilities in states with non-supportive CPC policy environments (p = 0.033). This remained true after adjusting for state abortion policy environment (p = 0.011). ConclusionsPregnancy confirmation is more accessible at CPCs compared to abortion facilities. Factors other than state-level CPC policies likely influence service accessibility. There is a need for improved access to pregnancy confirmation in medical settings. ImplicationsOur findings demonstrating that pregnancy confirmation is more accessible at crisis pregnancy centers than at abortion facilities are predicted to be exacerbated in the wake of abortion clinic closures following the Dobbs v Jackson Women's Health Organization Supreme Court decision. This highlights the need for improved funding and support for pregnancy confirmation service delivery in medical settings, including abortion facilities.