People Living with Low Incomes and Individuals Who Identify as Black Are Among Those More Likely to Have a Procedural Abortion than a Medication Abortion

National study examines characteristics of people obtaining medication and procedural abortions in clinical settings in the US

Individuals who identified as Black, those with incomes at or below the poverty level, and those paying with public or private insurance were more likely to have a procedural abortion than a medication abortion, according to a new study from the Guttmacher Institute that is based on its sixth Abortion Patient Survey.  

In addition, the analysis found that those who identified as Asian or White, had no prior births, had no prior abortions or were paying out of pocket were more likely to have a medication abortion. 

The study, published in Contraception, compares the characteristics of people obtaining medication and procedural abortions at 43 US facilities that offered both methods of abortion between June 2021 and July 2022. The analysis, which was restricted to those obtaining an abortion at less than 11 weeks of pregnancy, included responses from 4,717 individuals.  

“There is an abundance of research on the clinical aspects of medication abortion, such as efficacy and safety, but much less work has been done on the characteristics and potential preferences of people obtaining medication versus procedural abortions,” says Rachel Jones, principal research scientist at the Guttmacher Institute. “By centering individuals who obtain the abortions, this study sheds light on who may be most impacted in situations when procedural abortions are not available.” 

Key findings from the analysis include: 

  • More than half of respondents (57%) were having a medication abortion. 

  • Nearly one-quarter (24%) of respondents indicated they chose the clinic because it offered medication abortion, a proxy for preference, and 16% because it offered procedural abortion.  

  • Obtaining a medication abortion was highest among those who: 

    • Identified as Asian (69%) or White (65%),  

    • Had no prior abortions (62%), 

    • Had incomes at or above 100% the federal poverty level (60%–61%), 

    • Paid out of pocket (65%). 

  • Medication abortions were lowest among those who: 

    • Identified as Black (48%), 

    • Had family incomes below the poverty threshold (53%), 

    • Used insurance (Medicaid or private) to pay (49%). 

Even after controlling for preference, Black individuals and those with the lowest incomes were less likely to obtain a medication abortion, suggesting these groups may be more likely to opt for procedural abortions. These findings align with previous research showing that Black women and those who had had a previous abortion were less likely to prefer medication abortion and that White and Asian-identifying individuals were more likely to have medication abortion.    

The finding that poverty status is associated with procedural abortion is new. The authors suggest that individuals with limited financial resources may prefer a procedural abortion because of the brevity of the method compared with the time necessary to complete a medication abortion. However, further research is needed on the topic. 

“Prior to Dobbs, four in 10 clinics only offered medication abortion, and, post-Dobbs, research has documented an increase in the number abortions provided by virtual clinics, which only offer medication abortion,” says Jones, referring to the 2022 US Supreme Court decision that eliminated the constitutional right to abortion. “Our findings suggest that already marginalized populations may be most impacted when medication abortion is the only option available. Every person should have access to the method of abortion that best fits their specific needs and circumstances, including in-clinic procedural care.”    

The full analysis is available here.  

* The 2021–2022 Abortion Patient Survey contains data from a national sample of more than 6,600 individuals who obtained an abortion at a health care facility in the United States between June 2021 and July 2022. Guttmacher was ending data collection when the US Supreme Court issued its decision in Dobbs v. Jackson Women’s Health Organization.