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Objectives
To assess whether state-level mandatory delay policies cause patients to “time-out”
of accessing medication abortion.
Methods
North Carolina, a state with mandatory delays, was matched to Iowa, a comparator state,
using population demographics and enacted abortion legislation. North Carolina implemented
a 24-hour mandatory delay in 2011 and a 72-hour delay in 2015. Using CDC public data
from 2008 to 2018, annual rates of change in the proportion of medication-to-total
abortions were constructed for pre- and post-mandatory delay periods and compared
within and between states using piecewise generalized linear models. Proportions were
used to control for background national levels of decreasing total abortions and increasing
use of medication abortions.
Results
North Carolina's annual rates of change for medication abortions were 1.7% in 2008–2010,
4.9% in 2012–2014 (post 24-hour delay), and 1.9% in 2016–2018 (post 72-hour delay).
Iowa's corresponding annual rates of change were 1.2%, 1.8%, and 4.1%, respectively.
Compared to Iowa, North Carolina had a significant increase in the annual rate of
change after implementing the 24-hour delay (difference-in-differences=2.7% per year,
p<0.0001). After increasing the delay to 72 hours, North Carolina's annual rate of
change decreased while Iowa's increased (difference-in-differences=5.4% per year,
p<.0001).
Conclusions
A mandatory delay period of 72 hours was associated with decreasing annual rate of
change of medication-to-total abortion, even though medication abortion was increasing
as a proportion of total abortion care across the US. The increasing delays in accessing
care that will accompany the Dobbs v. Jackson Women's Health Organization decision are likely to make many patients similarly “time out” of accessing medication
abortion.
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© 2022 Published by Elsevier Inc.
