Abstract
Objective
To examine changes in travel distance and abortion incidence if Roe v. Wade were reversed
or if abortion were further restricted.
Study design
We used a national database of abortion facilities to calculate travel distances from
the population centroids of United States counties to the nearest publicly-identifiable
abortion facility. We then estimated these travel distances under two hypothetical
post-Roe scenarios. In the first, abortion becomes illegal in eight states with preemptive
“trigger bans.” In the second, abortion becomes illegal in an additional 13 states
classified as at high risk of outlawing abortions under most circumstances. Using
previously-published estimates of the short-run causal effects of increases in travel
distances on abortion rates in Texas, we estimate changes in abortion incidence under
each scenario.
Results
If Roe were reversed and all high-risk states banned abortion, 39% of the national
population of women aged 15–44 would experience increases in travel distances ranging
from less than 1 mile to 791 miles. If these women respond similarly to travel distances
as Texas women, county-level abortion rates would fall by amounts ranging from less
than 1% to more than 40%. Aggregating across all affected regions, the average resident
is expected to experience a 249 mile increase in travel distance, and the abortion
rate is predicted to fall by 32.8% (95% confidence interval 25.9–39.6%) in the year
following a Roe reversal.
Conclusion
In the year following a reversal, increases in travel distances are predicted to prevent
93,546–143,561 women from accessing abortion care.
Implications
A reversal or weakening of Roe is likely to increase spatial disparities in abortion
access. This could translate to a reduction in abortion rates and an increase in unwanted
births and self-managed abortions.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ContraceptionAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The supply-side economics of abortion.N Engl J Med. 2011; 365: 1466-1469
- Change in distance to nearest facility and abortion in Texas, 2012 to 2014.JAMA. 2017; 317: 437-439
- The impacts of reduced access to abortion and family planning services on abortions, births, and contraceptive purchases.J Public Econ. 2018; 167: 43-68
- How far is too far? New evidence on abortion clinic closures, access, and abortions.National Bureau of Economic Research. 2017; 23366
- Identifying National Availability of abortion care and distance from major US cities: systematic online search.J Med Internet Res. 2018; 20: e186
- Impact of clinic closures on women obtaining abortion services after implementation of a restrictive law in Texas.Am J Public Health. 2016; 106: 857-864
- Implications for women of Louisiana's law requiring abortion providers to have hospital admitting privileges.Contraception. 2015; 91: 368-372
Center for Reproductive Rights. What If Roe Fell n.d. https://reproductiverights.org/what-if-roe-fell [accessed June 9, 2019].
- Abortion Facilities Database, updated to reflect known changes through June. 2018; 1: 2019
- Center of Population by county: 2010.2010
- Surveillance, epidemiology, and end results program (SEER). SEER*stat database: Populations County-level population files. 1973-2017: 2019
- Stata statistical software: Release 15.College, Station, TX2017
- GEOROUTE, Stata module to calculate travel distance and travel time between two addresses or two geographical points.Boston College Department of Economics, Statistical Software Components2016
- Abortion incidence and service availability in the United States, 2014: abortion incidence and service availability in the United States, 2014.Perspect Sex Reprod Health. 2017; 49: 17-27
- Abortion incidence and service availability in the United States, 2014: abortion incidence and service availability in the United States, 2014.Perspect Sex Reprod Health. 2017; 49: 17-27
- Characteristics and circumstances of U.S. women who obtain very early and second-trimester abortions.PLoS ONE. 2017; 12
- The impact of Mississippi's mandatory delay law on the timing of abortion.Fam Plann Perspect. 2000; 32: 4-13
- Abortion before & after Roe.J Health Econ. 2013; 32: 804-815
- Change in second-trimester abortion after implementation of a restrictive state law.Obstet Gynecol. 2019; 133: 771-779
- The effect of parental involvement laws on teen birth control use.J Health Econ. 2016; 45: 55-62
- Innovative models are needed for equitable abortion access in the USA.Lancet Public Health. 2017; 2: e484-e485
- Women's experiences seeking abortion care shortly after the closure of clinics due to a restrictive law in Texas.Contraception. 2016; 93: 292-297https://doi.org/10.1016/j.contraception.2015.12.017
- Women's mental health and well-being 5 years after receiving or being denied an abortion: a prospective, longitudinal cohort study.JAMA Psychiat. 2017; 74: 169-178https://doi.org/10.1001/jamapsychiatry.2016.3478
- Does abortion reduce self-esteem and life satisfaction?.Qual Life Res Int J Qual Life Asp Treat Care Rehabil. 2014; 23: 2505-2513https://doi.org/10.1007/s11136-014-0687-7
- Comparison of health, development, maternal bonding, and poverty among children born after denial of abortion vs after pregnancies subsequent to an abortion.JAMA Pediatr. 2018; 172: 1053-1060https://doi.org/10.1001/jamapediatrics.2018.1785
- The effect of abortion on having and achieving aspirational one-year plans.BMC Womens Health. 2015; 15: 102https://doi.org/10.1186/s12905-015-0259-1
- Socioeconomic outcomes of women who receive and women who are denied wanted abortions in the United States.Am J Public Health. 2018; 108: 407-413https://doi.org/10.2105/AJPH.2017.304247
- Exploring the feasibility of obtaining mifepristone and misoprostol from the internet.Contraception. 2018; 97: 287-291https://doi.org/10.1016/j.contraception.2017.09.016
Article info
Publication history
Published online: July 31, 2019
Accepted:
July 18,
2019
Received in revised form:
July 16,
2019
Received:
June 25,
2019
Footnotes
☆This study received financial support from Middlebury College.
☆☆Declaration of interest: Myers reports having served in the past year as an expert witness in litigation involving abortion regulations. Jones and Upadhyay have no interests to declare.
★Financial support: This research received financial support from Middlebury College.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
