Disparities and Change Over Time in Distance Women Would Need to Travel to Have an Abortion in the USA: A Spatial Analysis

Summary

Background

• Abortion is a crucial part of women's healthcare and aids in fertility control.
• Access to abortion clinics influences the likelihood of obtaining an abortion.
• No national study has yet examined inequality in access to abortion and its evolution amid a decline in the number of abortion clinics.

Methods

• Data from the Guttmacher Institute's Abortion Provider Census (2000, 2011, 2014) was used.
• US Census Bureau data was used to analyze block groups and women aged 15-44.
• Calculated median distance to abortion clinics for women in counties and states.

Findings

• In 2014, the median travel distance to an abortion clinic was 1079 miles.
• 20% of women had to travel 4254 miles or more.
• Greater variation was noted within, rather than between, states.

Interpretation

• Persistent spatial disparities exist in abortion access in the USA.

Funding

• Study funded by an anonymous grant to the Guttmacher Institute.

Introduction

• Abortion is a key public health goal for fertility control.
• Barriers include stigma, restrictive laws, and financial constraints.
• Spatial inequality affects access and is increasing as clinics close.
• 28 million pregnancies in 2011 were unintended; 42% ended in abortion.

Research in Context

Evidence Before This Study

• Studies highlight spatial disparities in abortion access in high-income countries.
• No national US study had examined this inequality comprehensively.

Added Value of This Study

• First national estimates of spatial disparities in the US.
• Analysis of geographical distribution of women and travel distances.

Implications of All the Available Evidence

• Persistent spatial disparities in women's abortion access in the US and potentially in other high-income countries.

Methods

Study Design

• Data obtained from Guttmacher Institute for 2000, 2011, 2014.
• Analysis limited to facilities performing 400+ abortions annually.
• Considered only publicly accessible clinics, excluding low-volume and undisclosed providers.

Statistical Analysis

• Measured distance using population-weighted centroids for census block groups.
• Utilized Open Source Routing Machine to compute driving distances.
• Weighted block groups by number of reproductive-age women.
• Analyzed distances by urban-rural classification.

Results

• Half of women lived within 1079 miles of a clinic in 2014.
• States showed varied median distances, with some women traveling considerable distances.
• Counties showed greater variation in travel distance than states.
• Changes in distance between 2011 and 2014 were minor for most states.

Discussion

• Study provides first national estimates of travel disparity to abortion clinics.
• Economic disadvantage and restrictive laws compound access issues.
• Variability by county suggests local policies impact access more than state policies.
• Texas showed notable increase in travel distance due to restrictive laws.

Conclusion

• Abortion access is crucial for reproductive health.
• Spatial disparities persist and may worsen with further restrictions.

Acknowledgments

• Supported by an anonymous grant to the Guttmacher Institute.
• Acknowledged contributions from collaborators and reviewers.