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P029Barriers to abortion and timing of presentation for care

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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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