Examining the association between prior medical mistreatment and interest in and support for over-the-counter medication abortion among people seeking in-person abortion in the United States

While previous research indicates that most people seeking facility-based abortion care are interested in over-the-counter (OTC) access to medication abortion (MA), few studies have examined whether people who have experienced medical mistreatment support OTC access. We assessed whether prior experiences of medical mistreatment are associated with interest in and support for OTC MA among people seeking abortion care in the United States (US). We analyzed cross-sectional survey data from 9 US abortion facilities from June 2021 to December 2022, among people seeking in-person abortion ≥ 15 years old who spoke English or Spanish. Participants completed surveys on demographics, clinical characteristics, OTC MA interest/support, and prior experiences of medical mistreatment and their effects on subsequent care-seeking. We conducted unadjusted and adjusted regression analyses examining associations between history of medical mistreatment (none, having been ignored and/or ridiculed by healthcare providers, and having delayed or forgone care due to prior mistreatment) and interest in and support for OTC MA. Among 1,360 respondents, 39% reported prior experiences of medical mistreatment, of whom 48% (258/537) had delayed care and 40% (215/537) had forgone care due to mistreatment. Overall, 72% expressed interest in and 85% supported OTC MA. In adjusted analyses, compared to people with no history of medical mistreatment, a larger proportion of participants who had delayed or forgone care (302/1,360, 22%) due to prior mistreatment expressed personal interest in (82.8%, 95% Confidence Interval 77.0%-88.6% vs. 67.5% 61.4%-73.6%) and support for (93.7% 89.9%-97.5% vs. 80.5% 74.7%-86.3%) OTC MA. Many patients seeking abortion care in the US have previously experienced medical mistreatment and find OTC MA appealing, especially those who have delayed or forgone healthcare due to previous mistreatment. By prioritizing patient autonomy, agency, self-efficacy and accessibility, OTC MA could improve reproductive health outcomes and equity, particularly for those historically and repeatedly marginalized by healthcare systems.