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I think the answer is just that most don't know about them, having grown up in homes without them. They are quite nice though.
They may also be perceived as too expensive, if they only know of full toilet replacement kinds and not the seat replacements you can get for less than $100.
Cost me half that and I love it. It's a life changer.
Maybe, but I’d still go with having no idea such things exist. That was me, and the first type I knew about was the seat attachment/replacement
There are dozens of choices that work great for twenty some dollars online here in the US and don't even replace the seat.
I got a $400 one, and it was the best $400 I've ever spent. It's something I use every day, and damn does it improve my day just a little bit more.