• Posted May 16, 2022

When Abortion Means Traveling, More Women Forgo Procedure: Study

Long-distance travel will likely prove a nearly insurmountable barrier to some women seeking abortion if Roe v. Wade is overturned as expected, a new study concludes.

Women who need an abortion are more than twice as likely to delay the procedure or decide to continue their pregnancy if they live 50 or more miles from a clinic, compared with women who live within 5 miles of a clinic, the results showed.

"The very stark, loud implication of this study is that many people will not be able to overcome the distance barriers to reaching an abortion facility," said senior researcher Ushma Upadhyay. She is an associate professor of reproductive sciences with the University of California, San Francisco School of Medicine.

The findings come on the heels of a University of Utah-led paper that found that the average travel distance to an abortion clinic will increase threefold - from nearly 40 to more than 113 miles - if the U.S. Supreme Court overturns Roe and restrictive state legislation kicks in.

"Already, with 89% of counties not having abortion facilities, people are confronted with these driving distances," said Katie Watson, a lawyer and bioethicist with Northwestern University Feinberg School of Medicine, in Chicago.

"If Roe is overturned as we expect, and states are allowed to ban or severely restrict abortion, we will see these travel times go much higher for so many pregnant people," she added.

"This study is giving us a preview of our post-Roe world," Watson said.

A draft U.S. Supreme Court opinion written by Justice Samuel Alito that would strike down Roe v. Wade was leaked to the press earlier this month. It's not the final decision, but it shows that a majority of justices took an initial vote to do away with the decades-old ruling that provides federal protection for women seeking an abortion.

Upadhyay and her colleagues actually conducted their research years earlier, between August 2017 and May 2018, by reaching out through Google Ads to pregnant women who'd entered abortion-specific queries with the search engine.

"Most of the studies that have been done so far on barriers to abortion have interviewed patients at clinics," Upadhyay said. "We found that by interviewing people at abortion clinics, we were not picking up the people whose barriers were so insurmountable that they could never reach a clinic."

The researchers wound up surveying nearly 1,500 pregnant women, and conducted an additional follow-up survey one month later for more than 1,000.

By the month-later follow-up, results showed that:

• About 52% of people living within five miles of a clinic had gotten their abortion, compared with 35% of those living 50 or more miles from a clinic.
• About 30% of those living close to a clinic were still seeking an abortion, compared to 41% of those far from a clinic.
• About 20% of those close to a clinic and 24% of those living far away had decided to continue their pregnancy.

About nine out of 10 participants reported at least one distance-related barrier to obtaining an abortion, even if they lived in a community with a clinic, the researchers found.

For example, more than 60% of participants at any range from the nearest clinic said they had to gather money for travel expenses.

"This really underscores the fact that half of women who obtain abortions have incomes under the poverty line, which for a single person is about $13,000, and another quarter have incomes 100% to 200% of the poverty line," Watson said. "These people have to not only come up with cash for the procedure - they even have to figure out money to get there."

Keeping their abortion a secret was another powerful barrier, with more than 50% of all participants and more than 60% of those living far distances from a clinic citing this as a hurdle to travel.

This is an example of how abortion's stigma complicates women's access to the medical procedure, Watson said. Based on these findings, promises by some corporations to cover travel expenses for abortion likely will prove hollow, she added.

More than a dozen companies - including Microsoft, Amazon, Apple, Yelp, Citigroup, Lyft, Salesforce, United Talent Agency, and Levi Strauss & Co. - have promised employees that they will pay travel expenses for abortions if the procedure is outlawed or severely restricted where they live.

But many women won't care to disclose their personal health matters with company representatives, Watson said.

"You have to tell your HR person you're having an abortion," Watson said of the company policies. "I'm sitting in Salt Lake City, Utah, right now, and one of my medical colleagues here pointed out your HR person might be an elder in your Latter-Day Saints church."

"These are small towns. These are tight-knit communities. So if we're already seeing people saying I had to keep it a secret to friends and family, how likely is it you'll go to HR and tell them you need money to go get an out-of-state abortion?" Watson continued.

"I mean, it's wonderful that these companies are making that offer, and some employees will take them up on it, but it doesn't solve the problem," Watson concluded. "What we need is access that's local and private."

Upadhyay agreed with Watson.

"Companies would do better to lobby or appeal to their state legislatures to expand abortion rights," Upadhyay said. "I feel like employers paying for travel is very much a band-aid approach that also negates basic reproductive rights."

Other travel barriers cited in the study included the need to get time off from work or school; setting up transport to the clinic; making multiple trips to the clinic; and arranging for childcare and family care.

The advent of medication abortions could help reduce these travel barriers, but the researchers noted that provision of this service is limited by laws in 33 states that require it be administered by a physician.

Further, 19 states effectively ban people from being provided a medication abortion via telehealth, the researchers said.

"The federal government recently permanently lifted the in-person requirement for the provision of medication abortion, thereby allowing dispensing via telehealth and mail, but individuals in those 19 states cannot avail of this evolution in access," the study authors wrote in the report published online May 13 in JAMA Network Open.

More information

The American College of Obstetricians and Gynecologists has more about increasing access to abortion.

SOURCES: Ushma Upadhyay, PhD, MPH, associate professor of reproductive sciences, University of California, San Francisco School of Medicine; Katie Watson, JD, associate professor, obstetrics and gynecology, Northwestern University Feinberg School of Medicine, Chicago; JAMA Network Open, May 13, 2022, online