To explore the relationship between abortion care model and living in a state with an abortion ban with the psychosocial burden of care-seeking. From May 2021 to March2023, we surveyed patients obtaining medication abortion ≤70 days gestation, ages ≥15 years at four abortion clinic organizations in six U.S. states. We used negative binomial regression to assess three psychosocial burden dimensions: structural challenges (5 items, α=0.80), lack of autonomy (3 items, α=0.73), and others' reactions to the pregnancy (2 items, α=0.88) by abortion care model (no-test telehealth + mail, no-test + pickup, and in-person + ultrasound) and living in an abortion-ban state. 400 people completed psychosocial burden items. In adjusted analyses, no-test telehealth + mail was associated with less overall psychosocial burden (incident rate ratio [IRR] 0.82, 95% confidence interval [CI] 0.70, 0.95), including fewer structural challenges (IRR 0.78, 95% CI 0.67, 0.91) and less lack of autonomy (IRR 0.65, 95% CI 0.47, 0.90) than in-person + ultrasound, mostly due to less difficulty traveling (24% vs 32%, p < 0.05) and feeling less forced to wait after deciding (11% vs 22%, p < 0.05). People in abortion-ban states reported more psychosocial burden (IRR 1.62, 95% CI 1.26, 2.08) including more structural challenges (IRR 1.95 0.36, 95% CI 1.53, 2.29) than people in states without bans. No-test telehealth abortion care may reduce the psychosocial burden of care-seeking, especially the difficulties of travel and feeling forced to wait for care. Findings add to the body of evidence in support of expanding telehealth abortion care by reducing travel burden and potentially increasing autonomous decision-making when seeking abortion care.

Despite an absence of evidence that Rhesus (Rh) immunoglobulin is necessary before first-trimester medication abortion, many providers require routine Rh testing and Rh immunoglobulin. We sought to assess knowledge of blood type, receipt of Rh immunoglobulin, and interest in Rh testing and Rh immunoglobulin among patients seeking direct-to-patient telehealth medication abortion care and who may not otherwise need to travel to a clinic. We used data from the California Home Abortion by Telehealth (CHAT) Study, which included patients who sought medication abortion through telehealth in 20 states and Washington, D.C., in 2021-2022. We analyzed data from two CHAT study samples: survey data from 3 virtual clinics and electronic medical records (EMRs) obtained from one of those clinics. Patients were counseled on low risk of Rh sensitization at early pregnancy durations and referred for testing or treatment as preferred. Among 1,779 survey participants and 2,803 patients with EMR records, 51% and 52% respectively knew their blood type, of which 21% and 18% were Rh-negative. Among 189 Rh-negative survey participants, 6 (0.4%) obtained Rh immunoglobulin. In the EMR sample, among 1,341 patients with unknown blood type, 3% indicated interest in Rh testing, and 10% of the 263 Rh-negative patients indicated interest in receiving Rh immunoglobulin. Most patients who choose telehealth services for medication abortion opt out of Rh testing and treatment. Guidelines that mandate Rh testing and Rh immunoglobulin for first-trimester abortions should consider low patient interest alongside the lack of demonstrated clinical necessity.

The Ryan Program collaborates with obstetrics and gynecology (OBGYN) residency programs in the United States (U.S.) to ensure that abortion and contraception care are incorporated into resident curriculum as required. We sought to understand the impact of the Dobbs v. Jackson decision on OBGYN residency abortion training programs from the perspective of Ryan directors and to understand barriers and facilitators to maintaining abortion training in OBGYN residency programs post-Dobbs. We conducted qualitative, semi-structured in-depth interviews with Ryan program directors at U.S. academic medical centers. We coded the data iteratively and analyzed the data thematically. From January to April 2023, we conducted 24 interviews, representing 21% (n=23) of eligible U.S. Ryan directors. Participants were evenly distributed across four geographic regions of the U.S.; 50% (n=12) of participants were from programs in abortion-restrictive settings. Two themes emerged: (1) Ryan directors experienced stressors related to the administration of Ryan programs post-Dobbs, including perceived difficulty satisfying requirements for abortion training in restrictive states, burnout, and increased financial needs to support training partnerships. (2) Directors face challenges in recruitment and clinical care post-Dobbs. Increased state restrictions on abortion place logistical and financial burdens on OBGYN abortion training programs. Dobbs impacted training experiences across the U.S. and made it more difficult for many OBGYN residencies to provide abortion training. The research findings will inform strategies for improving the delivery of abortion education post-Dobbs. We anticipate findings will enhance procedures to establish and maintain partnerships post-Dobbs and identify areas where philanthropy and advocacy can be effectively utilized.