1. Greater distanced travelled for abortion services were associated with reduced abortion rates.
2. There is an unmet need for abortion care services across the US with higher distance travelled presenting an important barrier to access.
Evidence Rating Level: 2 (Good)
25% of women in the United States will have an abortion in their lifetime despite varying state policies and restrictions. Health care service closures, lack of facilities or abortion providers are barriers leading to greater distance to abortion services. Not surprisingly, this need for travel leads to additional barriers such as lack of follow up care, less likelihood of seeking aid, or simply the inability to do so. Lack of transportation, inability to take time off, financial or familial restrictions all may contribute to the problem. Therefore, the farther a patient lives from an abortion facility, the less likely they are to receive care. This national cross-sectional geographic analysis collected data from April 2018-October 2019 to further evaluate this relationship. Analyses were conducted with data from 3107 counties across 48 states. Data was collected from the 2015 American Community Survey as well as the US Census in order to calculate the abortion rates per 1000 females of reproductive age (15-44 years). Abortion rates were then compared between counties and distance travelled by car to receive care was calculated. The latter was found using the Advancing New Standards in Reproductive Health national abortion facility database. In the 48 states, there were an estimated 696 760 abortions with a mean abortion rate of 11.1 per 1000 female residents of reproductive age. Greater travel distance was negatively associated with abortion rates specifically, of the female residents of reproductive age reporting a travel distance of less than 5 miles where 21.1 per 1000 females received abortion care. On the other hand, when 120 miles or more of travel distance was reported, only 3.9 per 1000 female residents of reproductive age received abortion care. One limitation of the study was that the main barrier to access was presented as “travel distance” despite the multitude of other factors that play a role. Laws and state policies, religious beliefs, and underreporting due to stigma can all affect seeking care. Conversely, a strength of the study was the extensive analyses accounting for other factors such as race, age, marital status, education level, and income. Overall, abortion rates declining as travel distance to abortion care increases is clinically important as it indicates the need for more facilities and services. This need will be further exasperated should the US Supreme Court rule in favour for states to increase regulation or ban abortion. In order to focus on patient-centered care, increasing access to abortion services with less distance to travel is required.
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