Guttmacher Institute, Research Division, New York, NY, United States.
Guttmacher Institute, Research Division, New York, NY, United States.
Contraception. 2023 Dec;128:110137. doi: 10.1016/j.contraception.2023.110137. Epub 2023 Aug 6.
This study aimed to compare the characteristics of people obtaining medication and procedural abortions in clinical settings in the United States.
We conducted a cross-sectional survey of people obtaining abortions at a sample of 56 US facilities between June 2021 and July 2022. We restricted analyses to patients with pregnancies less than 11 weeks' gestation presenting at 43 clinics offering both medication and procedural abortion. We conducted bivariate analyses and multivariable logistic regression to identify factors associated with obtaining a medication vs procedural abortion.
Our analytic sample includes 4717 respondents, 57% of whom obtained a medication abortion. In bivariate analyses, individuals who identified as Asian or White, had no prior births or abortions, or were paying out of pocket were all more likely to have a medication abortion. Non-Hispanic Black individuals, those with incomes at or below the poverty level, and those paying with insurance were more likely to have a procedural abortion. Some 24% of respondents chose the facility because it offered medication abortion, but even after controlling for this proxy for method preference in a logistic regression model, Black respondents and those with poverty-level incomes were less likely to have a medication abortion.
The findings of the study suggest that Black individuals and those with low incomes-who often face systemic barriers to care-are less likely to have medication abortions. When medication abortion is the only option available, for example, at a medication-only clinic or from an online source, these groups may be most impacted by the lack of options.
To the extent possible, offering both medication and procedural abortion and increasing access to both types are important to meet patients' individual needs and preferences.
本研究旨在比较美国临床环境中获得药物和手术流产的人群特征。
我们对 2021 年 6 月至 2022 年 7 月在美国 56 家机构进行的一项横断面调查进行了分析，该调查包括了在提供药物和手术流产的 43 家诊所就诊、妊娠不足 11 周的患者。我们进行了单变量分析和多变量逻辑回归分析，以确定与获得药物流产与手术流产相关的因素。
我们的分析样本包括 4717 名受访者，其中 57%的人接受了药物流产。在单变量分析中，亚裔或白人、无既往生育或流产史、或自费的个体更有可能接受药物流产。非西班牙裔黑人、收入在贫困线及以下的个体，以及使用保险支付的个体更有可能接受手术流产。约 24%的受访者选择该机构是因为它提供药物流产，但即使在控制了模型中这种对方法偏好的代理变量后，黑人受访者和收入在贫困线以下的受访者接受药物流产的可能性仍然较低。
研究结果表明，黑人个体和低收入个体（他们经常面临着医疗保健系统障碍）接受药物流产的可能性较低。例如，在仅有药物流产的诊所或在线获得药物流产时，这些群体可能会受到缺乏选择的最大影响。
在可能的情况下，提供药物和手术流产，并增加这两种方法的可及性，对于满足患者的个体需求和偏好非常重要。
