Many states in the U.S. require pre-abortion counseling and a waiting period, which sometimes require two separate clinic visits. These rules are intended to ensure that women feel confident in their decision to have an abortion. Researchers wanted to see if being subjected to these laws leads to better decision-making.

The Google Ads Abortion Access Study is a prospective study of pregnant women considering abortion who were recruited online while looking for abortion-related keywords. Baseline and 4-week follow-up questionnaires were completed by eligible individuals from all 50 states in the 50 U.S. states. The Decisional Conflict Scale (scores range from 0 to 100; higher scores reflect lower certainty) was used to quantify decision certainty. A multivariable linear mixed model was used to investigate the relationship between living in states with waiting periods, two-visit restrictions, or both and changes in decision certainty. They also evaluated baseline, follow-up, and changes in decision certainty based on whether or not the pregnancy was still active at the time of the follow-up.

The analytic sample consisted of 750 people who provided pertinent baseline and follow-up data. At the time of the follow-up, 396 individuals had abortions and 354 had not. No significant increase in the decision certainty for participants in the states with waiting period laws (mean change score -1.0, 95% CI -2.8 to 2.8). In the models adjusted, seeking an abortion at 4-week follow-up was associated with the decrease in certainty (mean change score 8.05, 95% CI 5.13–10.97). People who are still thinking about abortion had less certainty (baseline score 28.8 and follow-up score 32.2) compared with those who obtained an abortion (baseline score 21.8 and follow-up score 20.1, P<.01). Among people who have had an abortion, decision certainty is quite strong and steady across time. Living in a state that requires a waiting period or two visits is not connected with improved decision certainty.