Distance to abortion facility and remaining pregnant

Now with Roe vs Wade overturned, “travel distance will only become more of a challenge for people trying to access abortion, with research projecting significant increases in average travel distance to reach a clinic,” said first author Elizabeth Pleasants, MPH, a doctoral candidate in public health at the University of California, Berkeley.

Individuals most affected by the ruling will be marginalized people who have historically faced obstacles in accessing abortion in the United States, according to Pleasants. “These are people of lower socioeconomic status, people of color, people living in rural areas and young people,” she said. “As these changes unfold across the country, research is needed to bear witness to the impacts of overturning Roe on travel distance, abortion outcomes and maternal health outcomes.”

The authors analyzed data from the Google Ads Abortion Access Study, which was a prospective cohort study of pregnant individuals from all 50 states and Washington, D.C. who were considering abortion and searching on Google for abortion resources. The 1,005 participants, recruited online between August 2017 and May 2018, completed an online baseline and a 4-week follow-up survey.

“A previous analysis of data from this cohort found that over half of participants had not obtained an abortion by the 4-week follow-up, with one-third still seeking an abortion and 20% had continuing their pregnancy,” Pleasants told Contemporary OB/GYN. “Given these outcomes and the known challenges posed to abortion access by long travel distances to reach a provider, we wanted to explore the impacts of distance to an abortion-providing facility on abortion attainment in this cohort.”

Among the 856 participants sampled, 51.8% were between the ages of 25 and 34 and 55.5% had some college education. Overall, 54.8% were White, 24.3% Black, and 11.8% Hispanic or Latinx.

Distance to an abortion facility was less than 5 miles for 27.2% of the sample, 5 to 24 miles for 43.6%, 25 to 49 miles for 9.9% and 50 or more miles for 19.3%, with a mean distance of 28.3 miles.

A full 89.1% of the sample reported experiencing at least one distance-related barrier to abortion access, like having to gather money for travel expenses or keep their abortion a secret, with a mean of 3.3 barriers reported.

Participants living farther from an abortion facility were more likely to report seven of eight distance-related barriers than those living less than 5 miles from a facility; for example, 81.2% of those living 25 to 49 miles and 75.8% of those living 50 or more miles from a facility reported having to gather money for travel expenses, compared to 61.8% who lived less than 5 miles away.

Additionally, at 4-week follow-up, participants living 50 or more miles from an abortion facility were roughly twice as likely to still be pregnant and seeking an abortion or planning to continue pregnancy compared to participants living within 5 miles of a facility.

“The finding that individuals living 50 miles or more from an abortion facility was associated with still being pregnant 4 weeks later suggests that travel distance to abortion facilities is a significant barrier to abortion access in the United States,” Pleasants said. “While this outcome is not in itself surprising, as it is aligned with findings of past research, it provides valuable information about the impacts of clinic accessibility on abortion access.”

The study also provides novel insights into the impacts of travel distance on access to desired abortion services among this hard-to-reach population of individuals living in states across the U.S. considering abortion, according to Pleasants.

“Because of increases in the number of state-level abortion restrictions during the past decade and concerns about the continued legality of abortion across America, travel distances to obtain abortions are likely to increase and be associated with decreases in abortion rates and increases in self-managed abortion, unplanned pregnancy rates, and maternal morbidity and mortality,” Pleasants said.

Innovative approaches to abortion care, such as making telehealth abortion widely available and integrating abortion into primary care practice, “present opportunities to mitigate the impacts of distance on access,” she said.

Reference

Pleasants EA, Cartwright AF, Upadhyay UD. association between distance to an abortion facility and abortion or pregnancy outcome among a prospective cohort of people seeking abortion online. JAMA Netw Open. Printed online May 13, 2022. doi:10.1001/jamanetworkopen.2022.12065