Informational and financial barriers at hospitals advertising abortion services

OBJECTIVES: To assess informational and financial barriers to abortion access at hospital facilities that advertise services by examining required calls, hold times, transfers, appointment availability, and costs encountered by callers seeking information about care. STUDY DESIGN: We used a mystery-caller design, posing as patients seeking abortions at a gestational age of 6 weeks, to contact all U.S. facilities currently advertising abortion services (N = 772). The primary outcome was whether hospital facilities (N = 48) presented informational barriers to abortion access. Secondary outcomes included appointment availability, wait times, and costs. We collected data on calls, transfers, hold times, appointment availability, and costs. Low information barriers were defined as: appointment information provided at the first call, fewer than two transfers, less than two minutes of hold time, and no patient chart requirement. Data were analyzed using descriptive statistics and comparative analysis between facility types. RESULTS: Ten of 48 hospitals required callers to leave a message and await a return call; 4 never returned the call. Among the 44 hospitals where contact was ultimately made, 75% were classified as presenting at least one information barrier: 41% required multiple calls, 14% multiple transfers, and 36% left callers on hold for more than 2 min. Only 52% of hospitals offered an appointment within one week, compared to 72% of non-hospital facilities. At hospital facilities, the median self-pay costs of an abortion were highly variable and systematically higher than those reported by other types of providers. CONCLUSIONS: Many hospitals that advertise abortion services online present substantial informational and financial barriers to patients, limiting timely access to care. IMPLICATIONS: Patients may contact hospitals expecting clinic-like accessibility, only to encounter unexpected barriers to obtaining information and scheduling an appointment. Reducing these barriers requires either significant operational restructuring or clearer patient guidance about how hospital abortion services differ from other types of facilities.