Johnson Dana M, Madera Melissa, Gomperts Rebecca, Aiken Abigail R A
The University of Texas at Austin, USA.
Aid Access & Women on Web, Amsterdam, the Netherlands.
SSM Qual Res Health. 2021 Dec;1. doi: 10.1016/j.ssmqr.2021.100003. Epub 2021 Aug 27.
Access to in-clinic abortion has become increasingly restricted in the U.S. and for many, the high cost of care is a significant barrier. However, little is known about how financial circumstances shape the alternate pathways to abortion care people seek when the clinic is out of reach. In a unique sample of people who used medication abortion pills from Aid Access, a non-profit telemedicine service, we examine the impact of economic circumstances on abortion care pathway decision-making and experiences seeking care. Between June and August 2019, we conducted 80 anonymous, semi-structured in-depth interviews with U.S. residents who self-managed their own abortions using medication abortion pills from Aid Access. Participants were asked about their experiences seeking abortion, and their motivations for using the service. We coded interviews using an iteratively developed coding guide and performed thematic analyses to identify key themes. The unaffordable cost of in-clinic abortion was a key reason why participants sought care using online telemedicine. Experiences of personal financial hardship exacerbated by restrictive policies impacted participants' ability to access the clinic. For participants with children, their financial decisions were further guided by the concerns of providing economic stability for their family. Although telemedicine was considered more affordable than in-clinic care, for some, the suggested donation of $90 still posed a financial burden and accessing pills at no cost or a reduced cost was necessary. The availability of affordable telemedicine and policy interventions addressing Medicaid and insurance coverage for abortion would democratize abortion access for populations with low incomes.
在美国，获得门诊堕胎服务的机会越来越受到限制，而且对许多人来说，高昂的医疗费用是一个重大障碍。然而，对于当门诊服务无法获得时，经济状况如何影响人们寻求堕胎护理的替代途径，我们却知之甚少。在一个独特的样本中，我们研究了使用非营利性远程医疗服务“援助通道”（Aid Access）提供的堕胎药的人群，探讨经济状况对堕胎护理途径决策和寻求护理经历的影响。2019年6月至8月期间，我们对80名美国居民进行了匿名的半结构化深度访谈，这些居民使用“援助通道”提供的堕胎药自行管理堕胎过程。参与者被问及他们寻求堕胎的经历以及使用该服务的动机。我们使用迭代开发的编码指南对访谈进行编码，并进行主题分析以确定关键主题。门诊堕胎费用过高是参与者寻求在线远程医疗服务的关键原因。限制性政策加剧的个人经济困难经历影响了参与者前往门诊就医的能力。对于有孩子的参与者来说，他们的财务决策还受到为家庭提供经济稳定的担忧的进一步影响。尽管远程医疗被认为比门诊护理更经济实惠，但对一些人来说，建议的90美元捐款仍然是一项经济负担，免费或以降低成本获取药丸是必要的。提供负担得起的远程医疗服务以及针对堕胎的医疗补助和保险覆盖范围的政策干预措施，将使低收入人群获得堕胎服务的机会更加平等。
