Access to Abortion Clinics Declines Sharply

Marcia Frellick

November 02, 2022

Estimated travel time to abortion facilities in the United States has increased significantly since the Supreme Court overturned Roe v. Wade, according to results from an original investigation published online in JAMA.

In the wake of the ruling, many clinics have closed and now 33.3% of females of reproductive age live more than an hour from an abortion facility, more than double the 14.6% who lived that far before the  Dobbs v. Jackson Women’s Health Organization court ruling, the paper states.

2022 study found that when people live 50 miles or more from an abortion facility they “were more likely to still be seeking an abortion on a 4-week follow-up than those who lived closer to an abortion facility,” wrote the authors, led by Benjamin Rader, MPH, from the Computational Epidemiology Lab at Boston Children’s Hospital.

Of 1,134 abortion facilities in the United States, 749 were considered active before the ruling and 671 were considered active in a simulated post-Dobbs period.

More Than 15 States Have Total or Partial Bans

The researchers accounted for the closure of abortion facilities in states with total bans or 6-week abortion bans, compared with the period before the ruling, “during which all facilities providing abortions in 2021 were considered active.” The authors noted that more than 15 states have such bans.

Researchers found median and mean travel times to abortion facilities were estimated to be 10.9 minutes (interquartile ratio, 4.3-32.4) and 27.8 (standard deviation, 42.0) minutes before the ruling and used a paired sample t test (P < .001) to estimate the increase to a median of 17.0 (IQR, 4.9-124.5) minutes and a mean 100.4 (SD, 161.5) minutes after the ruling.

The numbers “highlight the catastrophe in terms of where we are,” Catherine Cansino, MD, MPH, professor, obstetrics and gynecology at the University of California, Davis, said in an interview.

Behind those numbers, she said, are brick walls for people who can’t take off work to drive that far or can’t leave their responsibilities of care for dependents or don’t have a car or even a driver’s license. It also calculates only land travel (car or public transportation) and doesn’t capture the financial and logistical burdens for some to fly to other states.

Cansino serves on the board of the Society of Family Planning, which publishes #WeCount, a national reporting effort that attempts to capture the effect of the Dobbs decision on abortion access. In a report published Oct. 28, #WeCount stated the numbers show that since the decision, there were 5,270 fewer abortions in July and 5,400 fewer in August, for a total of 10,670 fewer people in the United States who had abortions in the 2 months.

For Cansino, the numbers are only one measure of the wider problem.

“If it affects one person, it’s really the spirit of the consequence,” she said. “It’s difficult to wrap your mind around these numbers but the bottom line is that someone other than the person experiencing this health issue is making a decision for them.

“You will see physicians leaving states,” she said, “because their hands are tied in giving care.”

Glimpse of Future From Texas Example

The experience of abortion restrictions in Texas, described in another original investigation published in JAMA, provides a window into what could happen as access to abortions continues to decrease.

Texas has banned abortions after detectable embryonic cardiac activity since Sept. 1, 2021. Researchers obtained data on 80,107 abortions performed between September 2020 and February 2022.

In the first month following implementation of the Texas law, SB-8, the number of abortions in Texas dropped by 50%, compared with September 2020, and many pregnant Texas residents traveled out of state for abortion care.

But out-of-state abortions didn’t fully offset the overall drop in facility-based abortions.

“This decrease in facility-based abortion care suggests that many Texas residents continued their pregnancies, traveled beyond a neighboring state, or self-managed their abortion,” the authors wrote.

Increased Time Comes With Costs

Sarah W. Prager, MD, professor in obstetrics and gynecology at University of Washington, Seattle, and director of the family planning division, explained that the travel time has to be seen in addition to the time it takes to complete the procedure.

Depending on state law, an abortion may take more than one visit to a clinic, which may mean adding lodging costs and overnight hours, or taking time off work, or finding childcare.

“A typical time to be at a clinic is upwards of 6 hours,” Prager explained, including paperwork, counseling, consent, the procedure, and recovery. That time is growing as active clinics overbook with others closing, she noted.

“We already know that 75% of people getting abortions are economically burdened at baseline. Gas is super expensive so the farther they have to drive – if they have their own car – that’s going to be expensive,” she noted.

In Washington, she said, abortion access is centralized in the western part of the state and located primarily between Seattle and Olympia. Though Oregon to the south has some of the nation’s most supportive laws for abortion, the other surrounding states have restrictive laws.

People in Alaska, Wyoming, Idaho, and Montana all have restrictive access, she noted, so people seeking abortions from those states have long distances to drive to western Washington and Oregon.

“Even for people living in eastern Washington, they are sometimes driving hours to get abortion care,” she said. “We’re really looking at health care that is dictated by geography, not by evidence, medicine, or science.”

The study by White and colleagues was supported by grants from the Susan Thompson Buffett Foundation and Collaborative for Gender + Reproductive Equity, as well as a center grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development awarded to the Population Research Center at the University of Texas at Austin. One coauthor reported receiving compensation from the University of Texas at Austin for providing data during the conduct of the study, as well as grants from Merck and Gynuity Health Projects and personal fees from Merck and Organon outside the submitted work; another reported being named plaintiff in the case Planned Parenthood of Montana v State of Montana, a lawsuit challenging abortion restrictions in that state. No other disclosures were reported. Cansino and Prager reported no relevant financial relationships.

This story originally appeared on MDedge.com, part of the Medscape Professional Network.

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