Abortion Clients' Perceptions of Alternative Medication Abortion Service Delivery Options in Mississippi.

OBJECTIVES: We assessed Mississippi abortion clients' perceptions of alternative medication abortion service delivery options that were restricted under state law but available elsewhere. METHODS: We conducted in-depth interviews with medication abortion clients between November 2020 and March 2021 at Mississippi's only abortion facility. We described alternative service delivery models: telemedicine, medications by mail, and follow-up care in their community versus returning to the facility. We asked if participants would be interested in using any of these models, if available, and how use of each model would have changed their abortion experience. We used thematic analysis, organizing codes into common themes based on participants' preferences and concerns for each option. RESULTS: Of the 25 participants interviewed, nearly all (n = 22) expressed interest in at least one option and reported that, had they been available, these would have alleviated cost, travel, and childcare barriers. Many believed these options would further ensure privacy, but a minority thought abortion was too sensitive for telemedicine or were concerned about mailing errors. Participants not interested in the alternative options also feared missing valued aspects of face-to-face care. Most did not return to the facility for follow-up (n = 19), citing financial and logistical barriers. Largely, participants were not interested in obtaining follow-up care in their community, citing concerns about provider judgment, stigma, and privacy. CONCLUSIONS: Mississippi abortion clients were interested in models that would make abortion care more convenient while ensuring their privacy and allowing for meaningful client-provider interaction. These features of care should guide the development of strategies aimed at helping those in restricted settings, such as Mississippi, to overcome barriers to abortion care following the implementation of abortion bans in many states following the overturn of Roe v. Wade.

Use of a contraceptive decision support tool in the abortion care setting.

OBJECTIVE: To evaluate the use of a contraceptive decision support tool in the abortion care setting. STUDY DESIGN: In 2019, Mississippi residents aged 18 to 45 used a tablet-based decision support tool at the consultation visit and completed a survey about their satisfaction with the tool. RESULTS: Among the 325 participants, the majority found the tool "very helpful" for method decision-making (86%) and considered the amount of information provided to be "just right" (95%). Nearly all (98%) reported it was acceptable to get contraception information at their visit. CONCLUSIONS: Decision support tools are a promising, person-centered strategy to support postabortion contraceptive information needs.

Insurance Churn and Inconsistent Access to Reproductive Health Care among Abortion Patients in Mississippi.

Changes in health insurance coverage, or insurance churn, is common in the months surrounding pregnancy, but there has been limited study of how churn affects women's experiences with reproductive health care. We conducted in-depth interviews with women seeking abortion care in Mississippi in 2016. We coded interview transcripts relating to experiences accessing reproductive health care before pregnancy and organized the codes into themes. Of the 38 women interviewed, one-third were uninsured and half described recent changes in their health insurance. This contributed to inconsistent care, as women shifted from private clinicians while insured to health department clinics while uninsured. For several women, these shifts created barriers to contraceptive use and were closely related to their unintended pregnancy. Insurance churn and associated disruptions in contraceptive use were common among Mississippi women seeking abortion in this study. Policies should support women's reproductive autonomy by facilitating consistent coverage and reliable access to contraception.

Women's Postabortion Contraceptive Preferences and Access to Family Planning Services in Mississippi.

BACKGROUND: Women's preferences for postabortion contraceptive care vary, and some may experience difficulties realizing their preferences owing to health systems-level barriers. We assessed Mississippi women's interest in postabortion contraceptive counseling and method use and the extent to which their method preferences were met. METHODS: In 2016, women ages 18 to 45 completed a self-administered survey at their abortion consultation visit in Mississippi and a follow-up phone survey 4-8 weeks later. Thirty-eight participants were selected for in-depth interviews. We computed the percentage of women who were interested in contraceptive counseling, initiating a method, and who obtained a method at the clinic. We also calculated the percentage who were using their preferred method after abortion and the main reasons they were not using this method. We analyzed transcripts using a theme-based approach. RESULTS: Of 323 women enrolled, 222 (69%) completed the follow-up survey. Of those completing follow-up, more than one-half (58%) reported that their consultation or abortion visit was the best time for contraceptive counseling, and 69% wanted to initiate contraception at the clinic. Only 10% obtained a method on site, and in-depth interview respondents reported they could not afford or did not like the options available. At the follow-up survey, 23% of respondents were using their preferred method. Women cited cost or lack of insurance coverage and difficulties scheduling appointments with community clinicians as reasons for not using their preferred method. CONCLUSIONS: Mississippi women have a large unmet demand for postabortion contraception. Policies that support on-site provision of contraception at abortion facilities would help women to realize their contraceptive preferences.