Abstract
Objectives. To determine differences in reasons for choosing telehealth abortion based on food insecurity status.
Methods. We analyzed data from the California Home Abortion by Telehealth (CHAT) Study, which included survey responses from patients who received medication abortion care between 2021 and 2022 from 1 of 3 virtual US clinics. Based on responses from 1726 survey participants, we used multivariable logistic regression to analyze differences in reported reasons for choosing telehealth abortion among individuals who experienced food insecurity versus those who did not.
Results. Compared with individuals in food-secure households, individuals who experienced food insecurity were more likely to choose telehealth abortion because of cost, challenges in finding transportation, challenges in finding child or dependent care, and concerns related to fear, judgment, and discrimination regarding care at an in-person clinic.
Conclusions. When seeking an abortion, individuals in food-insecure households consider many factors relevant to their abortion care preferences and reproductive health. Telehealth abortion, with its lower cost, may be particularly appealing to individuals who experience economic constraints. (Am J Public Health. 2026;116(5):674–682. https://doi.org/10.2105/AJPH.2025.308372)
Abortion is an essential form of health care, and access to this service is paramount to ensuring reproductive justice. Yet even before the Dobbs v Jackson Women’s Health Org. (No. 19-1392, slip op. at 5; US June 24, 2022) Supreme Court decision allowed states to completely ban abortion, people seeking an abortion in the United States combated economic barriers to accessing care. Costs are recognized as the greatest barrier to abortion care1,2 and can severely restrict access to reproductive services. Individuals who seek an abortion also confront other economic hardships that exacerbate the challenge of paying for the service. For instance, an individual seeking an abortion who lives far from their nearest provider may incur exorbitant costs because of travel or dependent care.3 Across the economic spectrum, people who seek an abortion describe these ancillary health expenses as hardships,3 but abortion access may be even more challenging for individuals navigating economic adversity.1
Food insecurity is an indicator of economic hardship. Individuals who experience food insecurity face arduous economic constraints, are more likely to live in lower-income households,4 and may forgo meals because of insufficient economic means.5 Defined as “limited or uncertain availability of nutritionally adequate and safe foods,”6(p1598) food insecurity affected 10.2% of US households in 2021, increasing to 12.8% of households in 2022.7 With respect to food insecurity and reproductive health care, research from 2018 related to economic hardship and abortion expenses in Texas1 shows that 17% of patients in low-income positions delayed purchasing groceries to pay for their abortion service. Because people seeking clinician-provided abortions are disproportionately of low income8 and consequently are more likely to experience food insecurity,4 knowing more about reproductive decision-making among individuals in food-insecure households can illuminate economic disparities in abortion access.
Telehealth abortion can increase abortion access by delivering medication through the mail, providing preabortion counseling, and offering follow-up services.9,10 Notwithstanding potential drawbacks of telehealth abortion for individuals who prefer in-person care,11 telehealth abortion is patient-centered and as safe and effective as in-person care.9,12 Increasingly utilized by people seeking an abortion, telehealth abortions accounted for 1 in 4 abortions by the end of 2024.13 Although data from 2021 to 2022 suggest that a considerable proportion of people seeking clinician-provided abortions are low income or living below the federal poverty level,8 the limited literature on people seeking abortion via telehealth before the Dobbs decision indicates that most had more than a high school education.14 However, data from after the Dobbs decision show that telehealth provision is higher in counties with higher rates of poverty.15
When making decisions about their care, individuals seeking a telehealth abortion consider a multitude of factors. Several studies document that, alongside comfort, privacy, and convenience, the lower cost of telehealth abortion is a top reason for choosing the service.11,14,16,17 These findings suggest that the economic aspects of telehealth services are critical for many people looking for an abortion. Thus, in our analysis, we sought to understand whether reasons for choosing telehealth abortion differed between patients in food-secure and those in food-insecure households.
Using food insecurity status as a measure of economic standing and a proxy for income level, we hypothesized that we would see significant differences in reasons for choosing a telehealth abortion based on food insecurity status. Relative to individuals in food-secure households, people who experience food insecurity will be more likely to choose a telehealth abortion because of cost and cost-related reasons (e.g., travel). Structural inequities can also contribute to distinct health care experiences18; therefore, compared to individuals in food-secure households, people who experience food insecurity will also be more likely to choose a telehealth abortion.
Our study fills a notable gap in public health research. By focusing on telehealth abortion—an underresearched topic in abortion scholarship—we extend conversations related to telemedicine, reproductive health care, and abortion access to new domains. Notwithstanding previous scholarship that documents myriad patient-reported benefits of a telehealth abortion,11 it is unclear whether specific subgroups (i.e., people seeking a telehealth abortion who also experience food insecurity) prefer telehealth for distinct reasons. Considering increased utilization of telehealth abortion13 and the millions of US households experiencing food insecurity,7 more research on reasons for choosing telehealth abortion, and importantly differences in those reasons based on social characteristics (i.e., economic position), is needed. Given the dearth of empirical work in this field of scholarship, our study addresses a notable shortcoming in the public health literature, refines the understanding of economic disparities in health care, and expands knowledge on reproductive decision-making.
Increasingly restrictive abortion policies in the United States further substantiate the relevance of our study. In a post-Dobbs landscape, people who seek an abortion encounter high prices for medication abortion via in-person care19 and lengthy travel times to brick-and-mortar abortion facilities.20,21 Policies such as the Hyde Amendment (1976) prohibit federal funding of abortions via Medicaid except in extreme cases. Because a considerable portion of Medicaid enrollees experience food insecurity,22 the Hyde Amendment exacerbates economic inequities in abortion access and threatens reproductive justice.23 Amid a contentious US political climate that continues to expand abortion bans, our work elucidates important variation across food insecurity status in telehealth abortion preferences and reproductive decision-making.
METHODS
We used data from the California Home Abortion by Telehealth (CHAT) Study—a longitudinal analysis of the safety, effectiveness, and acceptability of telehealth abortion care from 3 virtual clinics in the United States (i.e., Abortion on Demand, Choix, and Hey Jane). The clinics offered fully remote medication abortion care to patients as either synchronous or asynchronous services. The price of services from the clinics ranged from $199 to $289. The median price for an in-person medication abortion was $568 in 2021.19 Between April 2021 and January 2022, the CHAT Study collected electronic medical record data from all abortions provided by the participating facilities. Alongside electronic medical record data, patients were invited to complete 3 surveys at varying time intervals. In the first survey, administered at the time of abortion intake, survey participants were asked about initial reasons for choosing telehealth abortion and sociodemographic characteristics. Data in our study came from electronic medical records and the first survey. Our analytic sample included the 1726 participants with no missing data on our key study measures.
Measures
Our outcomes of interest included participants’ reasons for choosing telehealth abortion. Participants were asked, “Please tell us some of the reasons you wanted an abortion where your abortion pills were sent to you through the mail instead of going to a clinic?” The research team developed a closed-ended list of 15 reasons for choosing a telehealth abortion. The list included 9 reasons that were guided by early empirical work on telehealth abortion14 and 6 de novo items. Participants could select all the reasons that applied to their decision or “other” reasons. For further explanation, participants could also provide an open-ended response. If a participant’s open-ended response aligned with 1 or more of the 15 closed-ended responses, it was recoded where appropriate. Otherwise, the open-ended response was recoded as “other” reason. Specifically, 4 open-ended responses were recoded as “I want to have my abortion as soon as possible,” 4 open-ended responses were recoded as “other,” and 1 open-ended response was recoded as “Couldn’t take time off school or work.” Two open-ended responses included multiple reasons and were recoded as appropriate.
Our primary independent variable was food insecurity status. Asking about income in survey research may lead to unreliable data because of factors such as sensitivity, recall, and inaccurate reporting.24,25 Additionally, adolescents may not be aware of their family income. Hence participants were not asked to report their income level; rather, we assessed food insecurity status. The Household Food Security Survey is a validated survey assessment commonly used to screen for food insecurity status, but the complexity of the 18-item survey can restrict wide routine use.26,27 To enhance efficiency and minimize respondent burden, the Hunger Vital Sign, a 2-item screening tool that draws from the Household Food Security Survey, was developed in 2010.28 With high sensitivity (97%) and high specificity (83%), the Hunger Vital Sign identifies food-secure people using 2 questions and a 12-month recall period.28 A study using the 2-item Hunger Vital Sign survey and a 30-day recall period also revealed high sensitivity at 93%.27
Like Makelarski et al.27 we asked participants 2 questions and used a 1-month recall period. We asked participants first about the extent to which they were worried whether food purchased in the past month would run out before they had money to buy more and then whether the food purchased in the past month did not last and whether they did not have enough money to buy any more. For both questions, participants selected from 4 categorical responses: never, sometimes, often, or prefer not to answer. Following previous work,29 we categorized participants as food-insecure if they responded “sometimes” or “often” to either question or food-secure if they responded “never” to both questions. We removed participants with missing responses or who responded “prefer not to answer” to either food insecurity question from the analysis (n = 53; 3% of the starting sample).
Because research documents relatively younger and multiracial people as more likely to utilize telehealth abortion services,30 we adjusted for age, race, and ethnicity. We developed categorical measures for age at the time of the telehealth abortion (i.e., younger than 25 years, 25–29 years, 30–34 years, older than 34 years, and unknown age) using data from the electronic medical records. CHAT participants were also asked to self-report their race and ethnicity. The question included 5 response categories pertaining to racialized groups (i.e., Asian, Native Hawaiian, or Pacific Islander; Black or African American; American Indian or Alaska Native; Middle Eastern or North African; and White), 1 category for an ethnic group (Hispanic or Latinx/a/o), and a category for “other” race. Because of small sample sizes, we combined American Indian or Alaska Native with Middle Eastern or North African. Participants could select all racial and ethnic groups that applied. If participants selected 1 or more racial groups or included multiple racial groups in an open-ended response, we recoded them as “multiracial.” We recoded participants who selected “prefer not to answer” or “don’t know” or were missing data on race and ethnicity as “unknown.” Following Hummer,31 hereafter we refer to our categorical measure of race and ethnicity as ethnoracial.
Statistical Analysis
In our statistical analysis, we first described the characteristics of the entire analytic sample, both overall and stratified by food insecurity status. We then conducted difference-in-proportions tests to examine whether there were significant differences in sociodemographic characteristics and reasons for choosing a telehealth abortion among individuals who were categorized as food-insecure or food-secure. Next, we used multivariable logistic regression to assess the odds of a reason for choosing telehealth abortion. Each model adjusted for age at the time of the telehealth abortion and ethnoracial identity. We set the α level for all statistical tests at P < .05. We used Stata version 18.0 (StataCorp LP, College Station, TX) to conduct our statistical analyses.
RESULTS
Descriptive statistics are shown in Table 1. In all, 69% of the sample experienced food security, whereas 31% experienced food insecurity. Regarding the total study population, 52% of participants were racialized as White, 14% as multiracial, and 9% as Black; 13% identified ethnically as Hispanic or Latinx/a/o. Less than 10% of participants self-reported their ethnoracial identity as Asian, Native Hawaiian, or Pacific Islander (6%) and American Indian or Alaska Native or Middle Eastern or North African (1%). More than one fourth (26%) of participants were younger than 25 years, 24% were aged 25 to 29 years, 23% were between 30 and 34 years, and 19% were older than 34 years. Older participants and those who self-identified as Asian, Native Hawaiian, or Pacific Islander had a higher proportion in the food-secure category. Younger participants and those who self-identified as Hispanic or Latinx/a/o had a higher proportion in the food-insecure category.
TABLE 1—
Sample Size and Percentage Distribution by Participant Characteristics: California Home Abortion by Telehealth Study, 2021–2022
| Sociodemographic Characteristics | Total Participants (n = 1726), No. (%) | Food Secure (n = 1193; 69%), No. (%) | Food Insecure (n = 533; 31%), No. (%) | 95% CIa |
| Ethnoracial identity | ||||
| Asian, Native Hawaiian, or Pacific Islander | 112 (6) | 89 (7) | 23 (4) | (0.86, 5.42) |
| Black or African American | 153 (9) | 107 (9) | 46 (9) | (−2.54, 3.22) |
| Hispanic or Latinx/a/o | 229 (13) | 137 (11) | 92 (17) | (2.09, 9.46) |
| American Indian or Alaska Native, Middle Eastern or North African | 24 (1) | 19 (2) | 5 (1) | (−0.43, 1.74) |
| White | 900 (52) | 633 (53) | 267 (50) | (−2.14, 8.07) |
| Multiracial | 236 (14) | 157 (13) | 79 (15) | (−5.23, 1.91) |
| Unknown | 72 (4) | 51 (4) | 21 (4) | (−1.68, 2.35) |
| Patient age at abortion intake,b y | ||||
| < 25 | 445 (26) | 266 (22) | 179 (34) | (6.63,15.94) |
| 25–29 | 414 (24) | 292 (24) | 122 (23) | (−2.73, 5.91) |
| 30–34 | 406 (23) | 294 (25) | 112 (21) | (−0.61, 7.87) |
| > 34 | 326 (19) | 247 (21) | 79 (15) | (2.09, 9.68) |
| Unknown | 135 (8) | 94 (8) | 41 (8) | (−2.54, 2.92) |
Note. CI = confidence interval.
We drew 95% CIs from difference-in-proportions tests, comparing individuals in the food-secure group to individuals in the food-insecure group. For 95% CIs that do not cross zero, P < .05.
Age is from electronic medical records (EMRs). EMR data were missing for 135 patients.
Reasons for choosing telehealth abortion are reported in Table 2. In the overall sample, the most frequently reported reasons included being more comfortable at home (76%), wanting a more private and confidential abortion (59%), and finding telehealth less costly (57%). Notably, reasons for choosing telehealth abortion also varied by food insecurity status. Relative to their counterparts in food-secure households, respondents who experienced food insecurity reported higher proportions of choosing telehealth abortion because it was less costly (62% vs 54%; 95% confidence interval [CI] = 2.9%, 12.9%), they were worried about judgment or discrimination at a clinic (42% vs 34%; 95% CI = 2.5%, 12.5%), they were afraid of what would happen at the clinic (24% vs 16%; 95% CI = 4.2%, 12.6%), they did not have child or dependent care (17% vs 14%; 95% CI = 0.11%, 7.63%), or they lived a long-distance from the clinic or lacked transportation (11% vs 7%; 95% CI = 1.4%, 7.5%).
TABLE 2—
Sample Size and Percentage Distribution by Participants’ Reasons for Choosing Telehealth Abortion and Food Insecurity Status: California Home by Telehealth Abortion Study, 2021–2022
| Reasons for Choosing Telehealth Abortion | Total Participants (n = 1726), No. (%) | Food Secure (n = 1193; 69%), No. (%) | Food Insecure (n = 533; 31%), No. (%) | 95% CIa |
| More comfortable at home | 1309 (76) | 918 (77) | 391 (73) | (−0.86, 8.04) |
| Wanted more private and confidential abortion | 1022 (59) | 709 (59) | 313 (59) | (−5.73, 4.32) |
| Less costly | 978 (57) | 647 (54) | 331 (62) | (2.87, 12.86) |
| I want to have my abortion as soon as possible and I’m concerned going to a clinic may add time | 949 (55) | 678 (57) | 271 (51) | (1.10, 11.30) |
| Rather take care of own treatment | 764 (44) | 553 (46) | 211 (40) | (1.74, 11.79) |
| Could not take time off school or work | 651 (38) | 458 (38) | 193 (36) | (−7.02, 2.83) |
| Worried I’d be judged or discriminated against at a clinic | 633 (37) | 410 (34) | 223 (42) | (2.49, 12.45) |
| I didn’t want to see any clinic protesters | 549 (32) | 367 (31) | 182 (34) | (−1.42, 8.19) |
| Liked the mission | 535 (31) | 375 (31) | 160 (30) | (−3.28, 6.11) |
| Afraid of what happens at clinic | 328 (19) | 196 (16) | 132 (24) | (4.20, 12.64) |
| Didn’t have child or dependent care | 255 (15) | 162 (14) | 93 (17) | (0.11, 7.63) |
| I didn’t want tests | 209 (12) | 140 (12) | 69 (13) | (−2.17, 4.60) |
| COVID-19 and other infection concerns | 184 (11) | 119 (10) | 65 (12) | (−1.00, 5.48) |
| Distance or lack of transportation | 141 (8) | 81 (7) | 60 (11) | (1.43, 7.51) |
| Didn’t know where to go | 83 (5) | 57 (5) | 26 (5) | (−2.30, 2.09) |
| Other | 20 (1) | 12 (1) | 8 (2) | (−0.68, 1.67) |
Note. CI = confidence interval.
We drew 95% CIs from difference-in-proportions tests, comparing individuals in the food-secure group to individuals in the food-insecure group. For 95% CIs that do not cross zero, P < .05.
Conversely, individuals in food-insecure circumstances reported a relatively lower proportion of choosing telehealth abortion because they were concerned that going to a clinic might add time (51% vs 57%; 95% CI = 1.1%, 11.3%) or they would rather take care of their own treatment (40% vs 46%; 95% CI = 1.7%, 11.8%). We found similar results in our multivariable logistic regression models in which we predicted the adjusted odds of choosing telehealth abortion by food insecurity status, controlling for potential confounders (Figure 1).
FIGURE 1—
Associations Between Participants’ Food Insecurity Status and Reasons for Choosing Telehealth Abortion: California Home Abortion by Telehealth (CHAT) Study, 2021–2022
Note. AOR = adjusted odds ratio; CI = confidence interval. Sample size was n = 1726. AOR > 1 indicates higher odds among participants in food-insecure households relative to participants in food-secure households. AOR < 1 indicates lower odds among participants in food-insecure households relative to participants in food-secure households. We excluded “other” reasons from the multivariable logistic regression models because of data limitations. The model adjusts for age at time of telehealth abortion and ethnoracial identity.
DISCUSSION
In this study, we drew on survey data collected in a pre-Dobbs context to show how reasons for choosing telehealth abortion varied between individuals who experienced food security versus those who experienced food insecurity. Our findings reveal significant differences across economic position, suggesting that individuals who experience food insecurity have distinct abortion preferences and likely engage in unique decision-making processes when making choices about their reproductive health care.
As expected, we found that individuals who experienced food insecurity were more likely to choose telehealth abortion because the option was less costly. We show that the lower cost of telehealth abortion is preferable for individuals who experience economic constraints. Offering telehealth to patients at no cost would make abortion more economically feasible. Indeed, some telehealth providers are offering abortion care to people in states with abortion restrictions for as little as $5.32 Differences in cost-related reasons were also present. Relative to their food-secure counterparts, food-insecure individuals had a higher likelihood of choosing telehealth abortion because they were unable to travel to a clinic owing to distance, lacking transportation, or not having dependent care. Aligned with existing knowledge that out-of-state travel is often impossible for low-income individuals and other historically marginalized people seeking an abortion,21 we found that individuals who experience food insecurity may prefer telehealth because it mitigates, or at best eliminates, economic constraints related to ancillary abortion costs.
Our analysis also presents novel insights into differences in reasons for choosing a telehealth abortion because of concerns about judgment and discrimination at an in-person clinic, fear, timing, and a desire to take care of one’s own treatment. Compared with their counterparts, individuals who experienced food insecurity were more likely to pursue telehealth abortion because this service kept them away from a brick-and-mortar clinic—an environment where they anticipated encountering judgment or discrimination. Relatedly, people from food-insecure households were more worried about what happens at a clinic, leading them to utilize telehealth abortion. Factors such as low-income stigma18 may be salient deterrents to in-person abortion care for individuals in food-insecure households. When navigating the abortion care landscape, members of historically marginalized groups are likely acutely aware of discriminatory patterns in health care settings and may turn to alternative abortion care options, such as telehealth, to circumvent exposure to stigmatization.
The fact that individuals from food-insecure households were less likely to choose telehealth abortion for its promptness suggests that timing is a lower priority for individuals in this economic position. If people with lower incomes are likely to confront logistical hardships when seeking an abortion,33 having fewer economic resources to cover abortion costs could also mean that logistical setbacks precluded people in food-insecure households from receiving an earlier abortion. Assuming members of food-insecure households anticipated logistical battles, these individuals may have wanted an abortion sooner but considered timeliness a trivial facet of telehealth abortion if concurrently preparing to combat other, more pressing needs. Although beyond the scope of this analysis, understanding cognitive schemas among individuals who experience food insecurity when pursuing telehealth services is an important next step for abortion scholarship.
Additional research is also needed to unravel our significant finding related to patient-led care. People in food-insecure households were less likely to pursue a telehealth abortion because this service provided opportunities to care for their own treatment—a reason possibly tethered to agentic beliefs. Irrespective of economic constraints or type of abortion care, the ability to manage one’s health care is essential. Yet many individuals in food-insecure circumstances are combating structural factors (i.e., unaffordable housing).34 If months of food insecurity are coupled with structural obstacles that are perceived as uncontrollable, someone wanting a telehealth abortion might minimize their capacity for self-determination. Because acute attention has been given to telehealth abortion preferences, especially aspects of timing and agency, we draw attention to the novelty of our findings. We encourage researchers to expand on our study by using methodological approaches, such as qualitative analyses, that are well suited to exploring these complexities.
Although our study focused on variation in reasons for choosing a telehealth abortion, our findings have implications for research on telehealth abortion more broadly. Consistent with previous scholarship,11,14,16,17 we lend empirical muscle by also showing comfort, privacy, confidentiality, and cost as top reasons for choosing a telehealth abortion—regardless of food insecurity status. Consider that more than 50% of individuals in food-secure households in our study utilized telehealth because of its lower cost. People experiencing food insecurity likely garner the greatest economic benefit from telehealth abortion, but we suggest that telehealth’s affordability is attractive to a large swath of individuals. Increasing access to this highly desired form of care by reducing telehealth abortion costs would advance reproductive autonomy for people across the economic spectrum.
Limitations
Our findings should be considered alongside limitations. First, reasons for choosing a telehealth abortion may be shaped by previous exposure to discourse surrounding medication abortion or familiarity with receiving medication through the mail. Because of data limitations, we were unable to incorporate these potential confounders into our analyses. Second, we were unable to ascertain whether the lower price of telehealth abortion appeals to individuals who, in any other circumstance, would prefer an in-person abortion. Third, we recognize that the privileges associated with being in a food-secure position may vary by ethnoracial identity. However, given limited sample sizes in certain ethnoracial groups and subsequent statistical power issues, we were unable to estimate statistically meaningful interactions between ethnoracial identity and food insecurity status. Because experiences with classism are tethered to experiences of racism,25 more research is required to understand the intersecting systems of oppression that reduce options for reproductive care.
Conclusions
Despite these limitations, our study provides new insights into economic inequities in abortion access and should be considered alongside policy implications. The Hyde Amendment is a restrictive federal policy that, in most states, curbs reproductive autonomy by leaving individuals with Medicaid without comprehensive coverage for abortion care. Approximately 23% of Medicaid enrollees are food insecure, and a considerable portion are Black, Indigenous, or other people of color, meaning mandates such as the Hyde Amendment have a disproportionate impact on people seeking an abortion from historically oppressed groups.22,35 Repealing the Hyde Amendment is paramount for mitigating health inequity and advancing reproductive justice.
People seeking an abortion face costly prices for medication abortion via in-person care and exorbitant travel times to abortion facilities in a post-Dobbs landscape. Individuals in economically constrained situations prefer telehealth when striving to surmount cost-related barriers to abortion care and logistical complications. To ensure equitable access to reproductive health services, we must acknowledge the deeply entrenched economic inequalities in the United States, actively pursue efforts to uphold the fundamental tenets of reproductive justice, and strive to eliminate disparities in abortion access.
ACKNOWLEDGMENTS
This research was supported by the BaSe Family Fund, Erik E. and Edith H. Bergstrom Foundation, Isabel Allende Foundation, Jess Jacobs, Kahle/Austin Foundation, Lisa and Douglas Goldman Fund, Preston-Werner Ventures, and a Resource Allocation Program award from the University of California, San Francisco National Center of Excellence in Women’s Health. C. E. Williams was partially supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development via the Population Research Center at the University of Texas at Austin (grant P2CHD042849 and grant T32HD007081, Training Program in Population Studies). L. R. Koenig was funded in part by a training grant from the National Institute of Child Health and Human Development of the National Institutes of Health (NIH; award F31HD111277) for the duration of the study. U. D. Upadhyay’s time was funded in part by the National Institute of Child Health and Human Development, NIH (grant R01HD110659).
An earlier version of this article was presented at the 2025 Annual Meeting of the American Sociological Association.
The authors appreciate contributions to data collection and management and other input and research partnership on the CHAT Study from Jennifer Ko, Karen Meckstroth, Maricela Cervantes, Ena Suseth Vallardes, Linda Shin, Kelly Song, Stephanie Sumstine-Felice, Sun Cotter, Francine Coeytaux, and Elisa Wells as well as the collective efforts of all from the University of California Global Health Institute’s Center for Gender and Health Justice and California Latinas for Reproductive Justice. We thank Cindy Adam, Mark Adam, Kate Baron, Stephanie Bussmann, Leah Coplon, Lauren Dubey, Lindsay DuBois, Kiki Freedman, Gaby Izarra, Jamie Phifer, and Aisha Wagner for supporting data acquisition. We gratefully thank Christy L. Erving, Keif Godbout-Kinney, Ricardo H. Lowe, and Heather Rackin for their helpful comments, support, and detailed feedback.
Note. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the article.
CONFLICTS OF INTEREST
The authors do not have any competing interests to disclose.
HUMAN PARTICIPANT PROTECTION
The study was approved by the University of California, San Francisco institutional review board (#20-32951). All patients provided electronic consent.
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