Preferred Medication Abortion Support in the Southeastern United States, 2024-2025: A Discrete Choice Experiment

Medication abortion use is increasing in the United States following policy and legal changes since 2021. Multiple service options exist within and outside of the US health system, but limited evidence addresses individuals' preferences for medication abortion services and support.

We designed a discrete choice experiment with four attributes and accompanying levels: source of pills ("telehealth visit," "online order," "community network"), out-of-pocket cost ($0-$150), information support ("information sheet," "hotline," in-person "clinic consult," in-person "doula"), and material support (none, "essential care package," "self-care package"). We recruited pregnancy-capable individuals aged 18-45 in the southeastern United States using in-person community-based sampling in Mississippi and an online survey in Alabama, Georgia, Louisiana, and Mississippi from August 2024 to August 2025. We used Hierarchical Bayes modeling and simulations to quantify preferences.

We analyzed 215 respondents in Mississippi and 476 across the four-state sample. Respondents strongly preferred lower out-of-pocket cost followed by material support of an essential or self-care package. Preferences for information support and source of pills were weaker and differed by sample. In-person respondents preferred a community network as source and/or a doula for information support. Participants in the four-state sample preferred a telehealth visit or online order with a clinic consult. Interest in preferred options was high when out-of-pocket costs were below $50.

Out-of-pocket cost was the highest priority and source of pills the lowest; participants valued inclusion of a care package and interactive information support in different forms. These findings can inform medication abortion services.