Abstract
Objective
To assess the association between indicators of economic disadvantage and geographic
accessibility of reproductive health services and abortions ≥ 12 weeks’ gestation
in Mississippi.
Study Design
This cross-sectional study used data on Mississippi residents who obtained abortion
care from 12 of 14 facilities in Mississippi, Alabama, Louisiana, and Tennessee in
2018. We estimated logistic regression models to assess the association between levels
of county deprivation, the number of obstetrician and/or gynecologists per 10,000
women, and one way distance to the nearest facility with having an abortion ≥ 12 weeks’
gestation. We compared the median one-way distance to the facility where patients
< 12 weeks’, 12-15 weeks’, and ≥ 16 weeks’ gestation received care, using Kruskal-Wallis
tests.
Results
Of the 4,455 Mississippi residents who obtained abortions, 73% were Black, 59% lived
≥ 50 miles from a facility, and 60% obtained care in Mississippi. Overall, 764 (17.2%)
abortions were performed ≥ 12 weeks’ gestation. In adjusted models, those in counties
with moderate (OR, 1.47; 95% CI: 1.15-1.90) and high (OR: 1.36, 95% CI: 1.01-1.83)
(vs low) levels of economic deprivation and counties with 0.1-1.4 (vs ≥ 2.5) obstetrician/gynecologists
per 10,000 women (OR: 1.55; 95% CI: 1.06-2.27) had higher odds of obtaining an abortion
≥12 weeks’ gestation. Mississippi residents who obtained abortions ≥ 16 weeks’ gestation
traveled a median 143 miles one way to the facility where they received care, compared
to 69 miles and 60 miles traveled by those < 12 weeks’ and 12-15 weeks’ gestation,
respectively (p < .001).
Conclusions
Many Mississippi residents obtained abortion care ≥ 12 weeks’ gestation, which is
related to greater economic constraints and limited geographic access to reproductive
health services.
Implications
People's need for abortions ≥ 12 weeks’ gestation may be higher in communities with
limited access to reproductive health services and among those living in areas with
greater economic disadvantage. State laws that narrow gestational limits would increase
long-distance travel for later abortion care, and disproportionately affect those
with fewer resources.
Keywords
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Article info
Publication history
Published online: December 28, 2021
Accepted:
November 23,
2021
Received in revised form:
November 21,
2021
Received:
July 19,
2021
Footnotes
Funding: This project was supported by grants from the David and Lucile Packard Foundation (2018-67490) and an anonymous foundation, and a center grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (P2C HD042849) awarded to the Population Research Center at The University of Texas at Austin. The funders played no role in the design and conduct of the study; interpretation of the data; or preparation, review, or approval of this manuscript for publication.
Conflict of Interest: The authors declare that they have no conflicts of interest.
Identification
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