“I wouldn’t even know where to start”: unwanted pregnancy and abortion decision-making in Central Appalachia

Figures & data

Figure 1. Participants included in analysis, as compared to all study participants

Table 1. Participant demographics

	All study participants		Participants included in current analysis
Participant demographics	%	N	%	N
Total	100	53	100	31
Age (years)
16–20	15%	8	13%	4
21–25	32%	17	26%	8
26–30	19%	10	16%	5
31–35	17%	9	19%	6
36–40	9%	5	13%	4
41–45	8%	4	10%	3
Insurance
No insurance	40%	21	45%	14
Insurance provided by state	40%	21	32%	10
Private insurance	21%	11	23%	7
Relationship status
Not in a relationship	23%	12	23%	7
In a relationship	77%	41	77%	24
Live with partner	60%	32	55%	17
Married	23%	12	13%	4
Children
Not caring for children	40%	21	45%	14
Primary caregiver	60%	32	55%	17
1 child	25%	13	19%	6
2 children	25%	13	19%	6
3+ children	11%	6	16%	5
Education
Some high school	19%	10	13%	4
Completed high school degree	30%	16	35%	11
Some college	38%	20	39%	12
Completed college degree	13%	7	13%	4
Race
White	92%	49	90%	28
Black	8%	4	10%	3
Latino	0%	0	0%	0
Other	0%	0	0%	0

Figure 2. Framework for pregnancy and abortion assessment, decision to seek services, and pathway to services

Table 2. Matrix reflecting the unacceptability of abortion and of continuing pregnancy among participants

		Unacceptability of abortion
		Low	High
Unacceptability of continuing pregnancy	Low	“My first child, I got pregnant when I was 16. I thought about abortion, due to the fact that the father got deported. Well, then I was about three months, and my dad talked me out of it. I was 16 and I was like, ‘Well, the father’s not going to be there. I’m not going to have nobody.’ And my dad said he would help me. So I decided not to.” (Kentucky, mid-twenties, recruited at centre of commerce) Total participants = 2 Obtained an abortion = 1 Continued pregnancy = 1	“I don’t do abortions or anything like that. I’m not into that. I’m not trying to get pregnant. My dad has custody of my daughter right now, so I can be more financially stable, because I am going to school … He’s looked me in the face and told me not to have any more – or he told me that he couldn’t raise any more kids … I don’t want to be 21 with two kids right now. [Waiting for the pregnancy test results], it’s kind of scary. Other than that, I would be fine with it if that’s – I’m not trying to get pregnant, but if that’s the case then that’s fine. I can take it as it comes.” (Virginia, early twenties, recruited at primary care facility) Total participants = 8 Obtained an abortion = 0 Continued pregnancy = 8
	High	“I found out Tuesday. And I mean, it had always been – me and my boyfriend had talked about it, like? What if it happens? What are we gonna do? We’re both in college. I have a big future. He has a big future. It’s not something we want right now. It was a huge mistake. We’re very careful, so this is just kind of a really big shock … [my mom] thinks that abortion’s bad. But I feel like having a kid you don’t wanna take care of is bad.” (Tennessee, late teens, recruited at abortion facility) Total participants = 10 Obtained an abortion = 10 Continued pregnancy = 0	“I just – where I have a daughter and then I lost one, I didn’t … It was just hard to deal with, to make a decision. But I knew that I wouldn’t carry it full term, and chances were that it would have health problems at least … . I almost didn’t come this morning. But I decided to. I was scared and nervous and just confused. I didn’t know what was gonna happen here, if they were gonna be nice.” (Kentucky, early twenties, recruited at an abortion facility) Total participants = 11 Obtained an abortion = 4 Continued pregnancy = 7

Table 3. Resources and barriers in pathway to abortion services

	Example
Resources
Social support (family/friends) Emotional, appraisal, informational, or instrumental assistance received from family/friends	“I talked to my sister I live with. Actually, she’s the only one I told about me coming here today. She was very supportive. No matter what I do, she supports me and she’ll be there. She just looked at me and she’s like, ‘Are you okay?’ I’m like, ‘Yeah, I’m fine.’ She’s like, ‘I noticed you just looked really off lately.’ I’m like, ‘No, I’m good.’ She looked at me and she’s like, ‘What’s wrong?’ I just kind of looked up at her and I told her, ‘I’m pregnant,’ and we just cried. She was my age when she was pregnant with her child. But she ended up having the baby. I already knew that she had been here for an abortion, because she told me, obviously.” – Tennessee, early twenties, recruited at abortion facility
Modelling Observation of other’s abortion experience	“My friend had actually been [to the clinic] before. She had gotten pregnant by a guy that was abusing her, and she went – instead of telling him, she went and had it done. And me and her had been friends since high school. So I already knew that she had it done, and when I needed it, I called her and I said, ‘Do you care to drive me? Since you already know where it’s at, and it’ll save me some stress that morning.’” – Kentucky, mid-twenties, recruited at centre of commerce
Barriers
Isolation from social support Emotional, appraisal, informational, or instrumental assistance not received from family/friends	“It was really scary, and just felt like, ‘How did this happen to me?’ I couldn’t talk to my mom. It was really hard. He lives with his parents, and they didn’t know. You couldn’t really talk about it on the phone or anything. It just felt like I was having to keep such a huge secret, such a burden. It still is, even after all this is done.” – Kentucky, late teens, recruited at abortion facility
Isolation from social support (healthcare providers) Emotional, appraisal, informational, or instrumental assistance not received from healthcare providers	“[My doctor] is just the doctor my sister uses. It’s really the only doctor [where I live] … He’s nice. He’s sweet. He’s kind of more of a traditional person as well. My sister actually just had an abortion, and she had some complications. She couldn’t even tell her doctor about it because he would have dropped her as a patient, because he’s dropped a couple of his other patients for the same reason … [when she was pregnant with her first child], he was asking her if she was gonna keep the baby at first, and she said yes, and he said, ‘Okay, good. I let go of a couple of patients because they decided otherwise.’ – Tennessee, early twenties, recruited at abortion facility
Silence Absence of abortion narrative in community	“All I could do was look online, because I don’t know anyone in my area that has had this done. Or anyone that would really admit to it.” – Kentucky, early twenties, recruited at abortion facility