Abstract
Objectives
Although California is a state with supportive abortion policies, recent evidence
suggests people may still encounter barriers to obtaining timely abortion care. To
provide an in-depth understanding of these barriers and augment existing literature
focusing on restrictive and hostile states, we sought to understand the patient perspectives
of barriers to timely abortion care in Los Angeles, California.
Study design
We recruited participants from two, high-volume urban clinical sites and conducted
semi-structured interviews with 17 individuals who visited three or more clinics and/or
encountered more than 2 weeks between seeking and obtaining their abortion. Using
thematic analysis, we analyzed deidentified transcripts by first developing and applying
codes, then identifying overarching themes to describe barriers to timely abortion
care.
Results
Participants described three primary barriers leading to abortion care delay: (1)
difficulties in ensuring insurance coverage or securing authorization for abortion
care from private/employer-sponsored insurance, (2) inadequate screening resulting
in multiple appointments where desired care could not be provided, and (3) difficulties
with expeditious referrals to appropriate clinical sites. Participants also described
accumulated fatigue from facing layers of resistance when pursuing avenues for care.
Conclusions
Even in supportive abortion policy states, barriers to abortion care from insurance,
screening, and referral-related issues may result in delayed or unaccessed care, negatively
impacting patient experience. Understanding and mitigating reasons for delays are
critical to improving patient experience with abortion care.
Implications
Standardized telephone triage at local clinic facilities and streamlined MediCal authorization
of abortion services may mitigate barriers to timely abortion care.
Keywords
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Article info
Publication history
Published online: August 29, 2022
Accepted:
August 22,
2022
Received in revised form:
August 17,
2022
Received:
October 1,
2021
Footnotes
☆Funding: This research was supported with funding from Society of Family Planning (SFP) [grant number SFPRF20-11].
☆☆Declaration of competing interest: All authors declare no known competing financial interests or personal relationships that may have influenced the work reported in this paper.
Identification
Copyright
Published by Elsevier Inc.
