US adults' attitudes toward abortion as a (non)essential procedure during the COVID-19 pandemic

Background The American College of Obstetricians and Gynecologists (ACOG) state "abortion is healthcare" in their advocacy statement. During the COVID-19 pandemic, healthcare services were limited to those deemed "essential," and some conservative states' attorneys general classified abortion as "nonessential," against ACOG recommendations. Subsequent to the pandemic, the 2022 U.S. Dobbs v. Jackson Women's Health Organization decision eliminated the federal right to abortion, and many states have severely restricted abortion access, making it important to ask-do people consider abortion essential healthcare? Thus, we explored U.S. adults' opinions on abortion as an essential medical procedure. Methods We collected data via IPSOS's KnowledgePanel (R) from September 2020 to January 2021 in four waves, three of which are included in the present study. We asked, "Do you think abortion is an essential medical procedure?" (yes, no, unsure) with a follow-up open-ended question: "Please describe why you [think/do not think/are unsure] abortion is an essential medical procedure." Our sample comprised 1523 closed-ended and corresponding open-ended responses. We used descriptive statistics to examine closed-ended responses by wave and inductive qualitative content analysis to analyze open-ended responses collapsed across waves. Results Among closed-ended responses, 44-46% indicated abortion was an essential procedure, 32-35% indicated abortion was not essential, and 19-22% indicated unsure. Among open-ended responses, 49% stated abortion was an essential medical procedure because abortion is time-sensitive, a right, and prevents suffering. Of open-ended responses, 43% indicated the essentiality of abortion as a medical procedure depends on the reason. And 32% of open-ended responses said abortion is not an essential medical procedure because abortion is elective, wrong/murder, and other procedures should take precedence. We noted instances where closed-ended responses did not correspond with open-ended reasons. Conclusions Findings highlight the nuance in conceptualizing abortion as an essential medical procedure. Reasons provided by participants on the extent abortion is an essential medical procedure underscore the contextual nature of abortion attitudes found in previous research. Notably, people indicating abortion was not an essential medical procedure but providing explanations suggesting reasons to consider abortion essential, point to the need for more nuance in assessing abortion attitudes.