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Early pregnancy confirmation availability at crisis pregnancy centers and abortion facilities in the United States

  • Author Footnotes
    1 Present address: Thomas Jefferson University, 833 Chestnut Street, Philadelphia, PA USA.
    Kavita Vinekar
    Correspondence
    Corresponding author at: University of Pittsburgh, Department of Obstetrics, Gynecology and Reproductive Sciences, Pittsburgh, PA, United States.
    Footnotes
    1 Present address: Thomas Jefferson University, 833 Chestnut Street, Philadelphia, PA USA.
    Affiliations
    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
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  • Author Footnotes
    1 Present address: Thomas Jefferson University, 833 Chestnut Street, Philadelphia, PA USA.
    Marian Jarlenski
    Footnotes
    1 Present address: Thomas Jefferson University, 833 Chestnut Street, Philadelphia, PA USA.
    Affiliations
    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
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  • Author Footnotes
    1 Present address: Thomas Jefferson University, 833 Chestnut Street, Philadelphia, PA USA.
    Leslie Meyn
    Footnotes
    1 Present address: Thomas Jefferson University, 833 Chestnut Street, Philadelphia, PA USA.
    Affiliations
    University of Pittsburgh, Department of Obstetrics, Gynecology and Reproductive Sciences, Pittsburgh, PA, United States
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  • Author Footnotes
    1 Present address: Thomas Jefferson University, 833 Chestnut Street, Philadelphia, PA USA.
    Beatrice A. Chen
    Footnotes
    1 Present address: Thomas Jefferson University, 833 Chestnut Street, Philadelphia, PA USA.
    Affiliations
    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

    Magee-Womens Research Institute, Pittsburgh, PA, United States
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  • Author Footnotes
    1 Present address: Thomas Jefferson University, 833 Chestnut Street, Philadelphia, PA USA.
    Sharon L. Achilles
    Footnotes
    1 Present address: Thomas Jefferson University, 833 Chestnut Street, Philadelphia, PA USA.
    Affiliations
    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

    Magee-Womens Research Institute, Pittsburgh, PA, United States
    Search for articles by this author
  • Author Footnotes
    1 Present address: Thomas Jefferson University, 833 Chestnut Street, Philadelphia, PA USA.
    Sara Tyberg
    Footnotes
    1 Present address: Thomas Jefferson University, 833 Chestnut Street, Philadelphia, PA USA.
    Affiliations
    Magee-Womens Research Institute, Pittsburgh, PA, United States
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  • Author Footnotes
    1 Present address: Thomas Jefferson University, 833 Chestnut Street, Philadelphia, PA USA.
    Sonya Borrero
    Footnotes
    1 Present address: Thomas Jefferson University, 833 Chestnut Street, Philadelphia, PA USA.
    Affiliations
    University of Pittsburgh, Center for Innovative Research on Gender Health Equity, Pittsburgh, PA, United States

    University of Pittsburgh School of Medicine, Department of General Internal Medicine, Pittsburgh, PA, United States
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  • Author Footnotes
    1 Present address: Thomas Jefferson University, 833 Chestnut Street, Philadelphia, PA USA.

      Abstract

      Objectives

      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.

      Study design

      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.

      Results

      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).

      Conclusions

      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.

      Implications

      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.

      Keywords

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