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What attributes of abortion care affect people's decision-making? Results from a discrete choice experiment.

Contraception 2023 November 17
OBJECTIVES: We aimed to measure both stated and experimentally "revealed" abortion-provision preferences among US people with capacity for pregnancy.

STUDY DESIGN: In July 2022, we recruited US residents assigned female sex at birth and aged 18-55 using Prolific, an online survey hosting platform. We asked participants what first-trimester abortion method and delivery model they would prefer. We also assessed abortion care preferences with a discrete choice experiment, which examined the relative importance of the following care attributes: method, distance, wait time for appointment, delivery model (telehealth versus in-clinic), and cost.

RESULTS: More than half of the 887 respondents (59%) self-reported a slight (22%) or strong (37%) preference for medication compared to aspiration abortion; 11% stated no preference. Our discrete choice experiment found that cost and wait time had a greater effect on hypothetical decision-making than did method and delivery model (discrete choice experiment average importances=44.3 and 23.2, respectively, compared to 15.9 and 8.2, respectively). Simulations indicated that, holding other attributes constant, respondents preferred medication to aspiration abortion and telehealth to in-clinic care.

CONCLUSIONS: This study, the first to examine abortion preferences in the US using a discrete choice experiment, demonstrates the importance of wait time and cost in abortion care decision-making. Our work indicates that for this population, factors related to health care financing and organization may matter more than clinical aspects of care.

IMPLICATIONS: Although people in this study preferred medication to aspiration abortion and telehealth to in-clinic care, wait time and cost of care played a greater role in care decision-making. Focusing solely on clinical aspects of care (i.e., method, delivery model) may ignore other attributes of care that are particularly important for potential patients.

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