Support for and interest in alternative models of medication abortion provision among a national probability sample of U.S. women

Abstract

Objective: The objective was to assess women's personal interest in and support for three alternative models of medication abortion (MA) provision.

Study design: Using an online survey of a U.S. national, probability-based representative sample of women ages 18-49, we gauged personal interest in and general support for three alternative models for accessing abortion pills: (1) in advance from a doctor for future use, (2) over-the-counter (OTC) from a drugstore and (3) online without a prescription. We conducted multivariable analyses to identify characteristics associated with support for these provision models.

Results: Fifty percent (n=7022) of eligible women invited completed the survey. Nearly half (49%) supported and 30% were personally interested in one or more of the three access models; 44% supported advance provision, 37% supported OTC access, and 29% supported online access. Common advantages reported for advance provision, OTC and online access included privacy (49%, 29% and 46%, respectively), convenience (38%, 44% and 38%) and being able to end the pregnancy earlier (48%, 40% and 29%). Common disadvantages included concern that women might take the pills incorrectly (55%, 53% and 57%), not seeing a clinician before the abortion (52%, 54% and 53%) and safety (42%, 43% and 60%). History of abortion and experiencing barriers accessing reproductive health services were associated with greater support for the alternative models.

Conclusion: Women are interested in and support alternative models of MA provision, in particular, advance provision. However, they also reported concerns about incorrect pill use and not seeing a clinician beforehand.

Implications: Offering women more choices in how they access medication abortion, including options where they can safely self-manage their own care, has the potential to expand access to care.

Keywords: Abortion; Medication abortion; Mifepristone; Misoprostol.

Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.