Who is Missing?
To effectively address obstacles to abortion care, public health practitioners and policymakers need to understand the full range and impact of barriers experienced by abortion seekers. However, the mainstream approach to measuring barriers to abortion care relies on clinic-based study recruitment, a method that excludes people who are seeking or considering abortion care but fail to make it to a clinic. As such, abortion seekers facing the greatest barriers to care are rarely recruited into these studies, and their experiences are missing from our understanding of abortion access.
In 2017, Ibis launched Who is Missing?—a research project that involved gathering data on people who face the greatest barriers to abortion care, as well as the full nature and scope of those barriers. This project piloted web-based alternatives to clinic-based recruitment for abortion research in the United States, and findings revealed multiple, intersecting barriers to abortion care that ultimately deterred people from seeking—or prevented them from obtaining—a wanted abortion. Some barriers were consistent with those reported in studies that recruited patients from abortion clinics, including the inability to pay for the abortion; long distances to the nearest provider; logistical difficulties; legal restrictions on abortion; and abortion stigma. The study also identified another barrier: the preference for medication abortion and how that interacts with gestational limitations on medication abortion, which has not been widely emphasized in the existing literature, and requires alternative sampling methods to be more fully understood.
Moving forward, to identify the full range of possible intervention points and thereby target programmatic and policy efforts toward dismantling barriers and increasing access to abortion, additional research conducted on a larger scale over a longer time frame is needed.