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Objectives
We describe the types of barriers faced by people seeking abortion and their association
with later presentation for care.
Methods
From October 2019 to March 2020, we surveyed 1,089 patients seeking abortion at seven
US facilities. Using responses to 11 questions, we identified four distinct domains
of self-reported barriers: geographic, financial, logistical/personal, and legislative.
Using multivariable logistic regression, we investigated the relationship between
each domain and presenting for abortion after 70 days’ gestation.
Results
One-quarter of patients (25%) presented after 70 days’ gestation. About one-third
reported geographic (31.6%), financial (31.9%), and logistical/personal (29.5%) barriers.
A small proportion (5.14%) reported legislative barriers. One-third (35.5%) reported
no barriers. The median distance traveled to the clinic was 20.3 miles one way, and
one-third (30%) traveled more than 50 miles. In multivariable analyses, both financial
barriers (adjusted OR (aOR), 1.69; 95% CI, 1.16–2.46) and geographic barriers (aOR,
1.86; 95% CI, 1.27–2.72) were associated with presenting for care after 70 days’ gestation,
as was difficulty meeting basic needs (aOR, 1.57; 95% CI, 1.19–2.08). Distance from
the clinic, age, language spoken at home, past experiences of medical mistreatment,
and prior pregnancy were not significantly associated with presentation after 70 days’
gestation.
Conclusions
In a sample representative of people seeking facility-based abortion nationally, financial
and geographic barriers were most impactful in later presentations for care. Cost
and geographic barriers are only expected to increase with the impending Supreme Court
decision, highlighting the urgent need to expand financial and travel support and
alternative models of care.
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Copyright
© 2022 Published by Elsevier Inc.
