A Mixed-Methods Analysis of Abortion Attitudes and Perceptions among Women Living in Alabama and South Carolina

Legal induced abortion is a safe option for terminating a pregnancy for women of reproductive age in the United States (U.S.), though access has varied since the Roe v. Wade and Doe v. Bolton cases in 1973. Information is lacking on women’s attitudes toward and perceptions of abortion as well as on related constructs such as pregnancy attitudes and contraceptive use. Exploring these constructs is important in that it can provide much needed context to women’s reproductive life planning. This research aimed to explore perceptions of abortion access and safety and examine the potential associations between attitudes toward abortion access and pregnancy avoidance and contraceptive use, respectively, among women living in Alabama and South Carolina. Secondary data were from two representative, statewide surveys of reproductive-aged women (18-44 years) living in Alabama and South Carolina. This mixed-methods research used thematic analysis to categorize open-ended responses regarding perceptions of abortion access and safety and bivariate (χ2 tests) and multivariate analyses to assess the relationships between abortion attitudes and pregnancy avoidance and contraceptive use, respectively. In Study 1, half of women (50.0%) thought that an abortion was very or somewhat easy to obtain and less than half women (41.2%) perceived abortion as very or somewhat safe in their state. The most common open-ended response themes were abortion legality and restrictions and abortion as similar to any medical procedure. In Study 2, women who were ambivalent about pregnancy avoidance or who found it unimportant to avoid pregnancy were less likely to agree that safe, effective, and affordable methods of abortion care should be available to women in their community compared to those who found it important to avoid pregnancy (adjusted Odds Ratio (aOR), 0.53 and 0.55, respectively). In Study 3, contraceptive users were more likely to agree that safe, effective, and affordable methods of abortion should be available to women in their community than contraceptive non-users (aOR, 1.43). There are clear opportunities for key stakeholders in reproductive health and health policy to unite in efforts to create woman-centered practices, programs, and policies to meet the reproductive health needs of the women they serve