title: Women's Pathways to Abortion Care in South Carolina: A Qualitative Study of Obstacles and Supports.
abstract: Women seeking timely and affordable abortion care may face myriad challenges, including high out-of-pocket costs, transportation demands, scheduling difficulties and stigma. State-level regulations may exacerbate these burdens and impede women's access to a full range of care. Women's reports of their experiences can inform efforts to improve pathways to abortion care.
  
  
  
  In 2014, semistructured qualitative interviews were conducted with 45 women obtaining abortions in South Carolina, which has a restrictive abortion environment. Interviews elicited information about women's pathways to abortion, including how they learned about and obtained care, whether they received professional referrals, and the supports and obstacles they experienced. Transcripts were examined using thematic analysis to identify key themes along the pathways, and a process map was constructed to depict women's experiences.
  
  
  
  Twenty participants reported having had contact with a health professional or crisis pregnancy center staff for pregnancy confirmation, and seven of them received an abortion referral. Women located abortion clinics through online searches, previous experience, and friends or family. Financial strain was the most frequently cited obstacle, followed by transportation challenges. Women reported experiencing emotional strain, stress and stigma, and described the value of receiving social support. Because of financial pressures, the regulation with the greatest impact was the one prohibiting most insurance plans from covering abortion care.
  
  
  
  Further research on experiences of women seeking abortion services, and how these individuals are affected by evolving state policy environments, will help shape initiatives to support timely, affordable and safe abortion care in a climate of increasing restrictions.
authors.affiliation: Project manager, Department of Community Health Sciences, Boston University School of Public Health.
authors.forename: Judy
authors.initials: J
authors.lastname: Margo
authors.affiliation: Associate professor and associate chair of education, Department of Community Health Sciences, Boston University School of Public Health.
authors.forename: Lois
authors.initials: L
authors.lastname: McCloskey
authors.affiliation: Assistant professor of health law, policy and management, Boston University School of Public Health.
authors.forename: Gouri
authors.initials: G
authors.lastname: Gupte
authors.affiliation: Executive director, Provide, Cambridge, MA.
authors.forename: Melanie
authors.initials: M
authors.lastname: Zurek
authors.affiliation: Independent consultant, Torrance, CA.
authors.forename: Seema
authors.initials: S
authors.lastname: Bhakta
authors.affiliation: Associate professor, Department of Community Health Sciences, Boston University School of Public Health.
authors.forename: Emily
authors.initials: E
authors.lastname: Feinberg
mesh_terms: D000023:Abortion Applicants; D000028:Abortion, Induced; D000029:Abortion, Legal / Q000191:economics / Q000523:psychology*; D000293:Adolescent; D000328:Adult; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D019458:Insurance Coverage / Q000331:legislation & jurisprudence*; D011247:Pregnancy; D036301:Qualitative Research; D012017:Referral and Consultation; D057545:Social Stigma; D012944:Social Support; D013022:South Carolina; D013315:Stress, Psychological / Q000523:psychology*; D055815:Young Adult