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No-Test Screening Protocols May Disproportionately Exclude Structurally Oppressed Communities Who Could Benefit from
M Antonia Biggs1, Lauren Ralph1, Katherine Ehrenreich1
1Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California San Francisco, Oakland, California, USA.
Health Equity
|July 18, 2025
Summary
No-test medication abortion screening excludes many eligible individuals, particularly younger people and those facing food or housing insecurity. Improved criteria are needed for equitable access to this reproductive healthcare option.
Area of Science:
- Reproductive Health
- Medical Screening
- Health Equity
Background:
- Medication abortion offers a safe and effective option for pregnancy termination.
- No-test screening protocols aim to increase access by removing the need for certain clinical assessments.
- Disparities in healthcare access highlight the need to evaluate screening methods for potential biases.
Purpose of the Study:
- To compare ineligibility rates for medication abortion using no-test screening versus standard testing with ultrasound.
- To identify demographic and socioeconomic factors associated with ineligibility under no-test criteria.
- To assess the rate of false positives in no-test medication abortion screening.
Main Methods:
- Prospective survey and clinical assessment of patients seeking abortion across nine facilities in eight U.S. states (June 2021-December 2022).
- Eligibility for medication abortion assessed using both standard clinical guidelines with testing and a no-test protocol.
- Statistical analysis to determine ineligibility proportions, false positive rates, and associations with participant characteristics.
Main Results:
- A significantly higher proportion of patients were ineligible using no-test criteria (71.5%) compared to standard testing (21.1%).
- No-test criteria disproportionately excluded younger individuals (15-19 years) and those experiencing food or housing insecurity.
- Moderate/severe pelvic pain was the most common reason for ineligibility, particularly among younger, nulliparous individuals, and those with food or housing insecurity.
Conclusions:
- Current no-test medication abortion screening criteria may create significant barriers to care, excluding eligible individuals.
- Disparities in exclusion rates suggest that no-test protocols may exacerbate existing inequities in reproductive healthcare access.
- Further research is essential to refine no-test screening criteria for improved equity and accessibility in medication abortion services.
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