Mystery Client Methodologies to Evaluate Abortion Care and Access: A Scoping Review

Background: Misinformation, disinformation, and a lack of information about abortion impede access. Mystery shopping designs are well-suited for evaluating the availability, accuracy, and quality of health services. However, we lack understanding of their use in abortion research. Methods: Our team conducted a scoping review to synthesize evidence of mystery shopping methods in abortion research internationally. We followed the JBI methodology for scoping reviews and engaged the expertise of a clinical research librarian. We included all English and French language studies of abortion using mystery shopping methods (phone, in person, or other). We did not limit the search by date range or jurisdiction. Results: We included 40 studies in our review, published between 2006 and 2025. Settings included 13 countries: USA (13), India (5), Canada (3), Mexico (3), Turkey (3), Bangladesh (2), Colombia (2), Ghana (2), Indonesia (2), and one each in Kenya, Nepal, Tanzania, Zambia, and Latin America. Methods included calls (20), in-person visits (18), texts/online messages (3), and combinations of mystery shopping with interviews/surveys (7) and systematic online searching (2). Themes included service availability and information quality, with seven subthemes, which we mapped to elements of the Levesque framework of patient-centred access: Approachability; acceptability; availability and accommodation; affordability; and appropriateness. Conclusions: Where abortion is decriminalized, efforts to improve abortion can prioritize Levesque's concepts, such as ensuring care is affordable, culturally safe, and geographically proximal. Mystery shopping can proxy patient experience and be used as a validity check, such as comparing health professionals' self-reported practice with that experienced by mystery shoppers.