Findings from the choices about abortion CaRE options (CARE) study: A discrete-choice experiment

Our study aimed to quantify the extent to which individuals, when considering a hypothetical abortion at eight weeks gestation, accept tradeoffs across attributes of abortion care options. We also sought to evaluate the presence of different preference patterns and whether they are associated with respondent characteristics.

We designed a discrete-choice experiment based on qualitative interviews with providers, abortion advocates, and individuals with personal experience seeking abortion. Each respondent saw eight choice questions with two experimentally designed abortion care options described by study attributes of abortion type, wait time, travel distance, electronic documentation, and out-of-pocket cost and a no-abortion option. Respondents were recruited across abortion clinics, websites and a commercial panel. We estimated respondents' choices using random-parameters logit and latent-class analysis.

Overall, 500 individuals completed the survey. The majority (80.2%) of respondents chose one of the abortion care options across all choice questions; 18.2% chose the no-abortion option at least once. Latent-class analysis revealed three preference patterns: one class representing individuals favoring any abortion type that avoided a 4-week wait time and without electronic documentation and another representing individuals with choices highly sensitive to out-of-pocket costs. A small third class provided no preference information. Respondent characteristics were not associated with latent-class membership.

While out-of-pocket costs are a primary concern for some abortion seekers, a sizeable subset prioritizes expediency and privacy. Recognizing this preference heterogeneity may help abortion clinicians and support organizations deliver more patient-centered care.

Relevant to current threats to mifepristone availability, participants would still choose abortion even if their preferred type and mode of delivery were not available. Multi-pronged strategies to decrease wait times and to reduce out-of-pocket costs would help meet the needs and priorities of abortion seekers.