University of Pittsburgh, Department of Obstetrics, Gynecology and Reproductive Sciences, Pittsburgh, PA, United States; University of Pittsburgh, Center for Innovative Research on Gender Health Equity, Pittsburgh, PA, United States.
University of Pittsburgh, Center for Innovative Research on Gender Health Equity, Pittsburgh, PA, United States; University of Pittsburgh School of Public Health, Department of Health Policy and Management, Pittsburgh, PA, United States.
Contraception. 2023 Jan;117:30-35. doi: 10.1016/j.contraception.2022.08.008. Epub 2022 Sep 7.
Crisis 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.
We 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.
CPCs 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).
Pregnancy 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.
Our 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.
危机怀孕中心（CPC）旨在劝阻人们堕胎。有 25 个州出台了支持 CPC 的政策。我们的目的是：（1）描述 CPC 与全国堕胎设施相比，在早期妊娠确认方面的可及性；（2）了解州 CPC 政策在服务获取方面的作用。
我们对 445 家 CPC 和地理配对的堕胎设施进行了全国神秘来电者研究，以寻求怀孕确认的患者身份进行。设施类型（CPC 与堕胎设施）是目标 1 中的主要暴露因素。首次可用的早期妊娠预约的等待时间是主要结果。在目标 2 中，州级 CPC 政策指定（支持 CPC 与不支持 CPC）是主要暴露因素。CPC 与配对堕胎设施之间首次可用预约的等待时间差异≥7 天是主要结果。
CPC 提供当天预约的可能性高于堕胎设施（68.5%对 37.2%，p<0.0001），并且免费提供妊娠测试（98.0%对 16.6%，p<0.0001）。在 CPC 首次可用预约的中位数等待时间为 0 天（IQR 0，1），而堕胎设施为 1 天（IQR 0，5），p<0.0001。在 CPC 政策环境支持的州，与 CPC 配对的堕胎设施等待时间超过一周或更长时间的可能性较小，而在 CPC 政策环境不支持的州则相反（p=0.033）。在调整了州堕胎政策环境后，这仍然成立（p=0.011）。
与堕胎设施相比，CPC 提供的妊娠确认更容易获得。除了州级 CPC 政策之外，其他因素可能会影响服务的可及性。需要改善医疗环境中的妊娠确认服务。
我们的研究结果表明，与堕胎设施相比，妊娠确认在危机怀孕中心更容易获得，这一发现预计将在罗诉韦德案（Dobbs v Jackson Women's Health Organization Supreme Court decision）之后，堕胎诊所关闭的情况下加剧。这凸显了需要改善医疗环境中包括堕胎设施在内的妊娠确认服务的资金和支持。
