State abortion policies and Medicaid coverage of abortion are associated with pregnancy outcomes among individuals seeking abortion recruited using Google Ads: A national cohort study

Ushma D Upadhyay; Ashley A McCook; Ariana H Bennett; Alice F Cartwright; Sarah C M Roberts

doi:10.1016/j.socscimed.2021.113747

State abortion policies and Medicaid coverage of abortion are associated with pregnancy outcomes among individuals seeking abortion recruited using Google Ads: A national cohort study

Soc Sci Med. 2021 Apr:274:113747. doi: 10.1016/j.socscimed.2021.113747. Epub 2021 Feb 6.

Authors

Ushma D Upadhyay¹, Ashley A McCook², Ariana H Bennett³, Alice F Cartwright⁴, Sarah C M Roberts²

Affiliations

¹ Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, USA. Electronic address: ushma.upadhyay@ucsf.edu.
² Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, USA.
³ School of Public Health, University of California, Berkeley, USA.
⁴ Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA; Carolina Population Center, University of North Carolina at Chapel Hill, USA.

PMID: 33642070
DOI: 10.1016/j.socscimed.2021.113747

Abstract

Objective: A major challenge to understanding barriers to abortion is that those individuals most affected may never reach an abortion provider, making the full impact of restrictive policies difficult to measure. The Google Ads Abortion Access Study used a novel method to recruit individuals much earlier in the abortion-seeking process. We aimed to understand how state-level abortion policies and Medicaid coverage of abortion influence individuals' ability to obtain wanted abortions.

Methods: We employed a stratified sampling design to recruit a national cohort from all 50 states searching Google for abortion care. Participants completed online baseline and 4-week follow-up surveys. The primary independent variables were: 1) state policy environment and 2) state coverage of abortion for people with Medicaid. We developed multivariable multinomial mixed effects models to estimate the associations between each state-level independent variable and pregnancy outcome.

Results: Of the 874 participants with follow-up data, 48% had had an abortion, 32% were still seeking an abortion, and 20% were planning to continue their pregnancies at 4 weeks follow-up. Individuals in restricted access states had significantly higher odds of planning to continue the pregnancy at follow-up than participants in protected access states (aOR = 1.70, 95% CI = 1.08, 2.70). Individuals in states that do not provide coverage of abortion for people with Medicaid had significantly higher odds of still seeking an abortion at follow-up (aOR = 1.80, 95% CI = 1.24, 2.60). Individuals living in states without Medicaid coverage were significantly more likely to report that having to gather money to pay for travel expenses or for the abortion was a barrier to care.

Conclusions: Restrictive state-level abortion policies are associated with not having an abortion at all and lack of coverage for abortion is associated with prolonged abortion seeking. Medicaid coverage of abortion appears critical to ensuring that all people who want abortions can obtain them.

Keywords: Abortion; Barriers; Google ads; Hyde amendment; Internet; Medicaid coverage; Restrictions; State policy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Abortion, Induced*
Advertising
Cohort Studies
Female
Humans
Medicaid*
Policy
Pregnancy
Pregnancy Outcome
United States