Policy Matters| Volume 28, ISSUE 5, P387-392, September 2018

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



      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.


      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.


      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.


      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.
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      Julie Chor, MD, MPH, is an Assistant Professor of Obstetrics and Gynecology at the University of Chicago. Her research focuses on the use of lay health workers in reproductive health care, reproductive health disparities, and reproductive ethics.


      Sarah Garcia-Ricketts, BA, is a medical student at The University of Chicago's Pritzker School of Medicine. Her research interests are reproductive justice and LGBTQ health.


      Danielle Young, MPH, is a Research Specialist, in the Section of Family Planning and Contraceptive Research at the University of Chicago. Her research interests include maternal and child health, reproductive health, and health disparities.


      Luciana E. Hebert, PhD, is a Research Specialist in the Section of Family Planning and Contraceptive Research at the University of Chicago. Her research interests include gender, family planning, and adolescent health.


      Lee A. Hasselbacher, JD, is Policy Coordinator with the Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health (Ci3) at The University of Chicago. Her research interests are sexual and reproductive health law and policy.


      Melissa L. Gilliam, MD, MPH, is a Professor of Obstetrics and Gynecology and Pediatrics at the University of Chicago. Her research focuses on the adolescent sexual and reproductive health, reproductive justice, and positive youth development.