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P028Mandatory delay periods and patient access to medication abortion

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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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