Adolescents versus healthcare providers preferences for abortion services: evidence from a discrete choice experiment in Jiangsu, China

Unintended pregnancies and induced abortions among Chinese adolescents have emerged as a pressing public health concern. Discrepancies in service preference between the supply and demand sides may reduce service utilization and compliance among adolescents, potentially leading to suboptimal reproductive health outcomes. We conducted a discrete choice experiment (DCE) incorporating seven service attributes identified through literature review and expert consultation, including perioperative cost of abortion services, post-abortion contraceptive services, level of privacy and confidentiality, recommended post-abortion rest duration, recommended post-abortion sexual abstinence duration, potential adverse impacts on reproductive health, and facility type providing abortion services. Choice sets were generated using Bayesian D-optimal design. Participants comprised physicians and nurses directly involved in abortion services from relevant departments, along with adolescents aged 16–24 years recruited across 13 prefecture-level cities in Jiangsu Province. Conditional logit model and mixed logit model were employed to analyze the preference of adolescents and healthcare providers (HCPs) respectively. Additionally, the relative importance (RI), willingness to pay (WTP), and service acceptance probability for each attribute were calculated. A total of 294 adolescents and 475 HCPs participated in the survey. Preference analysis revealed that adolescents prioritized “level of privacy and confidentiality” (RI = 36. 00%) most, followed by “perioperative cost of abortion services” (RI = 30. 80%) and “potential adverse impacts on reproductive health” (RI = 26. 16%). HCPs similarly valued “level of privacy and confidentiality” highest (RI = 49. 67%), with “post-abortion contraceptive services” ranking second (RI = 18. 65%). WTP analysis revealed that both groups demonstrated a high willingness to pay for “facility type providing abortion services”, “potential adverse impacts on reproductive health”, and “level of privacy and confidentiality”, though adolescents exhibited higher marginal WTP. Providers required 670. 40 compensation for contraceptive service omission. The scenario simulation identified an optimal service package with minimal preference discrepancy between groups (ΔP = 0. 030). It is recommended to establish confidential service protocols aligned with adolescents’ physical and psychological characteristics, enhance their comprehensive understanding and acceptance of abortion services, and promote the synergy between service affordability and quality assurance, thereby systematically constructing an adolescent-friendly abortion service system.