Challenges Faced by Sexual Minority and Heterosexual People Seeking Abortion Care

Purpose: This study assessed and compared the number and types of challenges and expense delays experienced by sexual minority and heterosexual individuals seeking abortion care. Methods: We analyzed cross-sectional survey data from 1953 individuals who sought an abortion at 25 clinics in five US states from April 2020 to February 2023. The survey asked about 12 challenges (e.g., transportation, emotional burden, cost) and 4 expense delays (e.g., rent, food) associated with obtaining an abortion. We examined types and number of challenges and expense delays by sexual identity. We conducted negative binomial regression (number of challenges) and logistic regression (any expense delay) to quantify differences. Results: Most participants in the analytic sample (N = 1833) experienced at least one challenge to obtaining an abortion (90%), with sexual minority participants (n = 349) experiencing a greater median number of challenges than heterosexual participants (n = 1484) (4 [interquartile range = 2-6] vs. 3 [1-4]; p < 0.001). Sexual minority participants were also more likely to delay an expense (40% vs. 28%; p < 0.001). Adjusting for other factors, sexual minority participants experienced significantly increased challenges (adjusted incident risk ratio = 1.2; 95% confidence interval [CI] = 1.1-1.3) and had greater odds of delaying an expense (adjusted odds ratio = 1.6; 95% CI = 1.2-2.1). Conclusions: Sexual minority individuals face more challenges and are more likely to delay expenses to obtain an abortion. Thus, sexual minority individuals may need additional support specific to the challenges they face, including financial assistance, transportation, and psychosocial support. Addressing inequalities that disproportionately impact sexual minority individuals within society and reproductive health care will help ensure that abortion is more accessible.