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Who is missing? A qualitative examination of the potential impact of selection bias in clinic-based studies of abortion

Kelly Blanchard, Ibis Reproductive Health

Project abstract

Restrictions on abortion access, coverage, and funding in this hostile political climate create substantial barriers for women attempting to receive abortion care. These barriers disproportionately affect low-income women and people of color, but the full impact of financial barriers to abortion access remains unknown and innovative methodologic thinking is sorely needed. Traditional clinic-based study-designs suffer from selection bias, as sampling women from abortion clinics fails to account for women who have unintended pregnancies and would consider abortion but for financial, logistical, or other reasons, are unable to make it to an abortion clinic, even for a first visit.

We propose an exploratory study to identify innovative methodologies for identifying women who had unintended pregnancies, were interested in abortion, but did not pursue abortion as an option because of real or perceived financial barriers. Over the course of a one-year grant, we will:

  1. Examine non-traditional recruitment methodologies using social-media and social networks, and how they have been used in other fields to design recruitment strategies for the non-clinic sample. Concurrently, we will build relationships with potential non-clinic recruitment partners, including but not limited to: pharmacies, helplines, and community/public health clinics that provide information about abortion/ abortion referrals.
  2. Identify the most promising non-clinic based recruitment venues/techniques, develop and implement study recruitment methodologies for each identified venue/technique to establish feasibility of recruiting through such mechanisms.
  3. Conduct semi-structured interviews with recruited women to better understand their experiences seeking an abortion and the financial barriers they encountered.


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