One in four women in the United States will make the decision to end a pregnancy in her lifetime. The journey to access that important, life-changing health care, however, may be much longer and cumbersome than she anticipates. According to a new study in the Journal of Medical Internet Research, people who live in 27 US cities have to travel more than 100 miles to reach an abortion facility.
Taking a “patient-centered perspective,” researchers in California sought to document the location of places in the US that offer abortion services using a source most people can access—that is, the Internet. They then calculated the travel distances to these clinics from metropolitan areas with a population of 50,000 or more to get a better idea of availability.
After making phone calls and cross-referencing information to ensure their results were accurate, the study’s authors identified 780 abortion facilities; these clinics, however, were not distributed evenly throughout the country. In fact, 90 percent of US counties do not have an abortion provider. For example, six states have only one abortion facility; California, on the other hand, had 152. Additionally, Missouri had the highest ratio of women to facility with 1,365,575 per facility, while Maine had the lowest at 13,905 women per facility.
What was most telling about the availability of reproductive health care in the US, however, was the number of “abortion deserts”—that is, cities from which people have to travel more than 100 miles to get abortion care—researchers found. In total, more than three million people call these 27 cities home; they include diverse locales such as Casper, Wyoming; Springfield, Missouri; Lake Charles, Louisiana; and Chattanooga, Tennessee. Unsurprisingly, Texas—whose lawmakers are known for being extremely anti-abortion—had the most abortion deserts (10) out of any other state.
As the study’s authors point out, “The lack of access to a common reproductive health service such as abortion is a public health concern in that more women in these cities could be forced to carry unwanted pregnancies to term if they are unable to travel long distances to obtain abortion care.” For low-income women, that burden would be particularly heavy and long-lasting.
In addition to revealing geographical disparities, the study also sheds light on the experience of simply locating an abortion facility. Alice Cartwright, one of the authors on the study and project director at Advancing New Standards in Reproductive Health (ANSIRH), tells Broadly their goal was to model the “real-world availability [of abortion services] to the average person.” She admits, however, that Internet search results can sometimes be confusing.
During their data collection period (which took place in early 2017), researchers called to verify facilities weren’t crisis prevention centers (nonprofits that discourage women from terminating their pregnancies) when online information was unclear. “You look at those websites and sometimes they have a really nice layout, they might even have a tab on their websites that says ‘abortion care’ or ‘abortion services,’” Cartwright says. “But when you click on it and you start reading through it, you start to see that maybe they actually don’t provide abortion care. To the average person, that might not be actually clear until they call or maybe even go there.”
“We’ve looked at enough websites now,” she continues, “that we know that if you actually go to a clinic website, a lot of times they’ll tell you, ‘OK, you need to come this many hours ahead of time, it’s going to cost this much if you’re this many weeks pregnant.’ They actually list out detailed information, which they would not do on a crisis pregnancy website. It’s not always easy to distinguish between them.”
Ultimately, the study reveals the need to consider more innovative ways of helping people access these important health services, including expanding medication abortion-only services, increasing the use of telemedicine, and creating policies that tackle transportation burdens for reproductive health services. For instance, California recently expanded Medicaid to cover transportation costs for reproductive health care services, including abortion. Researchers also say allowing pharmacies to dispense mifepristone (one of the two drugs used in medication abortion) would improve access to early abortion care.
“We want to support access as much as we can in those places where it exists,” Cartwright says. “But we also need to think about innovative ways of reaching people as well.”