Women who lived farther from an abortion facility were more likely to experience delays in obtaining abortion care or were unable to access it, according to data published in JAMA Network Open.
The findings have added significance if abortion access in the United States becomes even more restricted in the future, leaving women to travel greater distances to receive care.
“Previous studies that examined barriers to abortion have frequently been done by interviewing patients at abortion clinics,” Elizabeth A. Pleasants, MPH, a doctoral candidate at the University of California School of Public Health in Berkeley, California, told Healio. “However, this study design excludes people with the greatest barriers to abortion — those who never made it to the clinic. This study was initiated to better understand the barriers people face by interviewing people seeking an abortion provider much earlier in the process — at the point of their search for abortion resources on Google.”
Defining the cohort, outcomes
Pleasants and colleagues analyzed data from the prospective Google Ads Abortion Access study, which used advertisements to recruit pregnant people in all 50 states and Washington, D.C, who were considering abortion — based on their internet search histories — between August 2017 and May 2018.
In total, 856 participants were eligible for analyses based on their responses in surveys at baseline and 4 weeks. The researchers reviewed survey responses to evaluate whether participants had an abortion, were still seeking an abortion or had decided to continue with pregnancy. They also reviewed participants’ responses regarding eight distance-related barriers to abortion care, which included:
- gathering funds for travel expenses;
- keeping the abortion secret;
- taking time off work/school;
- arranging for transportation;
- making multiple clinic visits;
- arranging for child care or care for another family member;
- distance; and
- not knowing where to get an abortion.
Prevalence, impact of barriers
The cohort mainly consisted of participants aged 25 to 34 years (51.8%) who were white (54.8%), had some college education (55.5%), had public health insurance (52.1%) and lived in states with restricted abortion access (60.2%).
“We found that overall, less than half (48%) of participants obtained their desired abortion 4 weeks later,” Pleasants said.
Most participants (89.1%) reported at least one distance-related barrier to abortion, and a mean of 3.3 barriers (95% CI, 3.2-3.5) were reported by the entire cohort. Participants living 25 to 49 miles or 50 miles or more from an abortion clinic were significantly more likely to report all distance-related barriers — excluding taking time off from work/school — compared with participants living less than 5 miles from a clinic.
Adjusted modeling showed that participants living 50 or more miles from an abortion facility were significantly more likely to still be pregnant and seeking an abortion (adjusted OR = 2.07; 95% CI, 1.35-3.17) or planning to continue with their pregnancy (aOR = 1.96; 95% CI, 1.06-3.63, respectively) compared with those living within 5 miles of a facility.
“Our findings highlight that travel distance to reach a clinic is already a substantial barrier to abortion access in the U.S.,” Pleasants said. “As abortion becomes even more restricted, travel distance will only become more of a barrier to abortion care. Innovative approaches to abortion provision — such as telehealth provision and effective support for self-managed medication abortion — can mitigate the harmful effects of long travel distance to reach an abortion clinic.”
In light of the upcoming Supreme Court decision on Dobbs v. Jackson Women’s Health Organization, Pleasants said more research on the impact of distance on abortion access is necessary.
Perspective
Julia Strasser, DrPH, MPH
Abortion is essential, time-sensitive health care. However, patients seeking abortion care face significant barriers to obtaining these services, including cost, stigma and, in some cases, significant travel distances to reach an abortion provider.
This study examined the association between travel distance to the nearest facility providing abortions and pregnancy outcome — whether an individual obtained an abortion, was still seeking an abortion or planned to continue the pregnancy — in a cohort of 856 participants seeking information about abortion services.
The study found that the mean distance to an abortion facility is 28.3 miles, and that participants living 50 miles or more from a facility had approximately twice the odds of still being pregnant and seeking an abortion or planning to continue the pregnancy compared with participants living within 5 miles.
Rigorous research from the Turnaway Study tells us that when people who want abortions can’t obtain them, they are more likely to have health complications and other problems throughout their lives. While the study described above is not nationally representative, it suggests that there will be significant implications of greater travel distance to abortion providers — a problem that will substantially escalate as states ban or restrict abortion in the coming months and travel distances increase.
Reference:
The Turnaway Study. https://www.ansirh.org/research/ongoing/turnaway-study. Accessed May 18, 2022.
Julia Strasser, DrPH, MPH
Senior research scientist at the George Washington University Milken Institute School of Public Health
Disclosures: Strasser reports no relevant financial disclosures.
Reproductive & Maternal Health Resource Center
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