Well-woman Care Barriers and Facilitators of Low-income Women Obtaining Induced Abortion after the Affordable Care Act

Womens Health Issues. 2018 Sep-Oct;28(5):387-392. doi: 10.1016/j.whi.2018.03.009. Epub 2018 May 7.


Objectives: This study uses the abortion visit as an opportunity to identify women lacking well-woman care (WWC) and explores factors influencing their ability to obtain WWC after implementation of the Affordable Care Act.

Methods: We conducted semistructured interviews with low-income women presenting for induced abortion who lacked a well-woman visit in more than 12 months or a regular health care provider. Dimensions explored included 1) pre-abortion experiences seeking WWC, 2) postabortion plans for obtaining WWC, and 3) perceived barriers and facilitators to obtaining WWC. Interviews were transcribed and analyzed using ATLAS.ti.

Results: Thirty-four women completed interviews; three-quarters were insured. Women described interacting psychosocial, interpersonal, and structural barriers hindering WWC use. Psychosocial barriers included negative health care experiences, low self-efficacy, and not prioritizing personal health. Women's caregiver roles were the primary interpersonal barrier. Most prominently, structural challenges, including insurance insecurity, disruptions in patient-provider relationships, and logistical issues, were significant barriers. Perceived facilitators included online insurance procurement, care integration, and social support.

Conclusions: Despite most being insured, participants encountered WWC barriers after implementation of the Affordable Care Act. Further work is needed to identify and engage women lacking preventive reproductive health care.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Abortion, Induced / economics
  • Abortion, Induced / statistics & numerical data*
  • Adult
  • Female
  • Health Care Reform / economics
  • Health Care Reform / statistics & numerical data*
  • Health Personnel
  • Health Services Accessibility / economics
  • Health Services Accessibility / statistics & numerical data*
  • Humans
  • Insurance Coverage / organization & administration
  • Insurance Coverage / statistics & numerical data*
  • Insurance, Health / economics*
  • Interpersonal Relations
  • Interviews as Topic
  • Patient Protection and Affordable Care Act*
  • Poverty*
  • Pregnancy
  • Qualitative Research
  • Self Efficacy
  • Social Support
  • Socioeconomic Factors
  • United States
  • Young Adult