Barriers to Abortion Care and Their Consequences For Patients Traveling for Services: Qualitative Findings from Two States

Abstract

CONTEXT Abortion availability and accessibility vary by state. Especially in areas where services are restricted or limited, some women travel to obtain abortion services in other states. Little is known about the experience of travel to obtain abortion. METHODS In January and February 2015, in-depth interviews were conducted with 29 patients seeking abortion services at six facilities in Michigan and New Mexico. Eligible women were 18 or older, spoke English, and had traveled either across state lines or more than 100 miles within the state. Respondents were asked to describe their experience from pregnancy discovery to the day of the abortion procedure. Barriers to accessing abortion care and consequences of these barriers were identified through inductive and deductive analysis. RESULTS Respondents described 15 barriers to abortion care while traveling to obtain services, and three major consequences of experiencing those barriers. Barriers were grouped into five categories: travel-related logistical issues, system navigation issues, limited clinic options, financial issues, and state or clinic restrictions. Consequences were delays in care, negative mental health impacts and considering self-induction. The experience of barriers complicated the process of obtaining an abortion, but the effect of any individual barrier was unclear. Instead, the experience of multiple barriers appeared to have a compounding effect, resulting in negative consequences for women traveling for abortion. CONCLUSION The amalgamation of barriers to abortion care experienced simultaneously can have significant consequences for patients.

Motivations and Experiences of People Seeking Medication Abortion Online in the United States

“…Our findings demonstrate that there are many reasons people in the United States may seek self‐managed medication abortion from online sources. The financial and logistical challenges those living in states with hostile abortion policies experienced when trying to access clinical care are consistent with those described in prior work examining the effects of restrictive abortion laws . However, those living in states with middle‐ground and supportive laws also experienced access barriers, including long distances to clinics, lack of transportation and difficulty finding information.…”

Subsequent Unintended Pregnancy Among US Women Who Receive or Are Denied a Wanted Abortion

“…Women who carry unintended pregnancies to term are more likely to enter prenatal care late and have fewer prenatal visits; they are more likely to smoke cigarettes, less likely to breastfeed their infants, or they breastfeed them for shorter lengths of time; and they may be at greater risk of maternal depression and anxiety than women who continue intended pregnancies. Unintended pregnancies that women decide not to carry to term lead to a need for abortion services, which are increasingly expensive and difficult to access …”

“…Unintended pregnancies that women decide not to carry to term lead to a need for abortion services, which are increasingly expensive and difficult to access. [7][8][9] Seventeen percent of women nationally experience more than one unintended pregnancy in their lifetimes. 10 There are few studies that examine how the resolution of an unintended pregnancy, whether in birth or abortion, affects the likelihood of having a subsequent unintended pregnancy.…”

Identifying National Availability of Abortion Care and Distance From Major US Cities: Systematic Online Search (Preprint)

“…20 weeks) [8,9], instituting mandatory waiting periods [10,11], and restricting medication abortion [12,13]. Studies from several states have reported negative effects related to these laws and the subsequent reduced access, such as increased travel time, increased transportation and childcare costs, lost wages, the need to take time off of work or school, the need to disclose the abortion to more people than desired, and overall delays in care [10,12,14].…”

“…Although women may not always know where to go for abortion care [15], they often use the internet to find abortion facility information [14]. Online searching for abortion information appears to be more prevalent in states with restrictive abortion laws and in those where abortion availability is limited, suggesting that women with reduced access to abortion are more likely to seek out information on abortion access online [16,17].…”