Real-Time Effects of Payer Restrictions on Reproductive Healthcare: A Qualitative Analysis of Cost-Related Barriers and Their Consequences among U.S. Abortion Seekers on Reddit

Abstract

Objective: The Hyde Amendment and related policies limit or prohibit Medicaid coverage of abortion services in the United States. Most research on cost-related abortion barriers relies on clinic-based samples, but people who desire abortions may never make it to a healthcare center. To examine a novel, pre-abortion population, we analyzed a unique qualitative dataset of posts from Reddit, a widely used social media platform increasingly leveraged by researchers, to assess financial obstacles among anonymous posters considering abortion. Methods: In February 2020, we used Python to web-scrape the 250 most recent posts that mentioned abortion, removing all identifying information and usernames. After transferring all posts into NVivo, a qualitative software package, the team identified all datapoints related to cost. Three qualitatively trained evaluators established and applied codes, reaching saturation after 194 posts. The research team used a descriptive qualitative approach, using both inductive and deductive elements, to identify and analyze themes related to financial barriers. Results: We documented multiple cost-related deterrents, including lack of funds for both the procedure and attendant travel costs, inability to afford desired abortion modality (i.e., medication or surgical), and for some, consideration of self-managed abortion options due to cost barriers. Conclusions: Findings from this study underscore the centrality of cost barriers and third-party payer restrictions to stymying reproductive health access in the United States. Results may contribute to the growing evidence base and building political momentum focused on repealing the Hyde Amendment.

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“…There are numerous publications devoted to collecting data from social media, i.e. Reddit (Higgins et al, 2021), Twitter (Hernandez-Suarez et al, 2018; Dongo et al, 2021), Facebook (Mancosu & Vegetti, 2020). There are even manuals concerning scraping data from the web and social media and using it in analytics (Russell, 2013).…”

“I'm going to be forced to have a baby”: A study of COVID‐19 abortion experiences on Reddit

“…Abortion challenges both within and outside of the formal healthcare system were compounded by the financial stress felt by many during the initial stages of the pandemic. Due to the Hyde Amendment's ban on federal Medicaid funding for abortion, most women, transgender men, and other reproductive‐age people capable of pregnancy live in states without publicly subsidized coverage for abortion‐related healthcare, even though Medicaid covers prenatal and birthing care costs 30,31 . Thus, patients must pay out‐of‐pocket for both the $500–$1000 in procedural costs as well as costs related to travel, time off from work, and childcare to distant clinics involving unnecessary multiple visits 32–34 .…”

“…Our final data set contained 168 posts spanning from March 20, 2020 until April 13, 2020. Each day garnered an average of 22 posts (range [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31], and the number of posts gradually increased over the 4 weeks, concluding on April 13, 2020. The included posts averaged of 302 words, roughly half a single-spaced page, with a range of 17 words to 5119 words (a many-paragraph story).…”

The Dobbs Decision and the Future of Occupational Health in the US

“…People with low income often have little flexibility in schedules and need to work every day and hour possible to earn enough to cover everyday costs such as food and housing; taking time away from work would generate less income at the same time as creating more costs for people who can afford neither. Costs for abortion were prohibitive even before the Dobbs decision (see Higgins et al, 2021a , b ), but travel estimates suggest that the distance to the closest abortion facility will increase from 25 to 122 miles, and that 26% of women will have to travel more than 200 miles to access abortion care (Myers et al, 2019 ). This has direct implications for cost increases (e.g., gas, public transportation) as well as indirect implications (e.g., hotel stays, more lost wages).…”

“…While most of the discussion around the Dobbs decision rightly focuses on its impact on reproductive freedom, OHP researchers also should address potential impacts on healthcare personnel. Studies show that a substantial majority of healthcare providers believe that abortion services should be accessible to patients with few or no restrictions (Dodge et al, 2016 ; Schmuhl et al, 2021 ; Higgins et al, 2021a , b ). Higgins et al also found that 83% of a large sample of physician respondents expressed concerns about restrictive abortion laws making it difficult to recruit faculty and 66% reported worrying about effects on trainee recruitment.…”