Abortion Waiting Periods and Decision Certainty Among People Searching Online for Abortion Care

Many U.S. states mandate counseling and a waiting period before abortion, which often necessitates two separate clinic visits. These laws purport to ensure individuals are certain about their abortion decision. We examined whether exposure to these laws is associated with increased decision certainty.

The Google Ads Abortion Access Study is a prospective study of pregnant people considering abortion recruited when searching online using abortion care-related keywords. Eligible participants, who represented all 50 U.S. states, completed baseline and 4-week follow-up surveys. We measured decision certainty using the Decisional Conflict Scale (scores range from 0 to 100; higher scores reflect lower certainty). We used a multivariable linear mixed model to examine the association between living in states with waiting periods, two-visit requirements, or both and changes in decision certainty. We also compared baseline, follow-up, and changes in decision certainty by whether the pregnancy was ongoing or not at follow-up.

The analytic sample included 750 participants who contributed relevant baseline and follow-up data. At follow-up, 396 participants had an abortion, and 354 had not. There was no significant increase in decision certainty for participants in states with waiting period laws (mean change score -1.0, 95% CI -2.8 to 2.8). In adjusted models, still seeking an abortion at 4-week follow-up was associated with decreased certainty (mean change score 8.05, 95% CI 5.13-10.97). Those still seeking abortion had significantly lower certainty (baseline score 28.8 and follow-up score 32.2) than those who had obtained an abortion (baseline score 21.8 and follow-up score 20.1, P<.01).

Decision certainty is relatively high and stable over time among those who had had an abortion. Living in a state with a waiting period or two-visit requirement is not associated with increased decision certainty.