Denial of Abortion Because of Provider Gestational Age Limits in the United States

Upadhyay, Ushma D.; Weitz, Tracy A.; Jones, Rachel K.; Barar, Rana; Foster, Diana Greene

doi:10.2105/ajph.2013.301378

Cited by 150 publications

(139 citation statements)

References 20 publications

Supporting

Mentioning

135

Contrasting

Order By: Relevance

“…For midlife women, concerns related to their age, such as the increased risk of a fetal genetic anomaly or the belief that their family is complete, may also be a factor in their decision. Currently, 19% of all pregnancies in the US end in abortion; most (90%) take place in early pregnancy (before 13 weeks' gestation) [32], and are performed or initiated in ambulatory clinic [33,34].…”

Section: Is Abortion An Option?mentioning

confidence: 99%

“…• Offers more privacy as abortion occurs at home (or other chosen place) • May be accessible in remote/less-densely populated areas trimester and 1.5% in the second trimester or later among those who had an abortion procedure [34]. Serious abortion related adverse events (clinical errors) or morbidity (conditions due to pregnancy or abortion process) are rare and are defined as those resulting in intervention (surgical repair for uterine perforation, transfusion for hemorrhage) occur less than 0.1%) and hospitalization for pelvic infection/sepsis or hemorrhage occur less than 0.5%.…”

Section: Are Abortions Safe?mentioning

confidence: 99%

“…Serious abortion related adverse events (clinical errors) or morbidity (conditions due to pregnancy or abortion process) are rare and are defined as those resulting in intervention (surgical repair for uterine perforation, transfusion for hemorrhage) occur less than 0.1%) and hospitalization for pelvic infection/sepsis or hemorrhage occur less than 0.5%. [34]. The most common nonserious (minor) adverse event (incomplete abortion) or morbidity (continued uterine bleeding) often requires reaspiration or repeat abortion in an outpatient setting [60].…”

Section: Are Abortions Safe?mentioning

confidence: 99%

See 2 more Smart Citations

Unintended pregnancy: a framework for prevention and options for midlife women in the US

Johnson-Mallard

Kostas-Polston

Woods

et al. 2017

womens midlife health

View full text Add to dashboard Cite

Recently unintended pregnancies have been described as "a new kind of mid-life crisis." Given the high prevalence of unwanted or mistimed pregnancy in the US, we examined the sexual and reproductive health patterns of sexually active midlife women. An examination of the prevalence of unintended pregnancy among midlife women revealed a gap in data indicating unmet sexual and reproductive health needs of midlife women. The application of a framework for primary, secondary and tertiary prevention for unintended pregnancy may assist with guiding care for women and identifying implications for reproductive health policy and potential political interference as they relate to sexual and reproductive health in midlife women.

show abstract

Section: Is Abortion An Option?mentioning

confidence: 99%

Section: Are Abortions Safe?mentioning

confidence: 99%

Section: Are Abortions Safe?mentioning

confidence: 99%

See 1 more Smart Citation

Unintended pregnancy: a framework for prevention and options for midlife women in the US

Johnson-Mallard

Kostas-Polston

Woods

et al. 2017

womens midlife health

View full text Add to dashboard Cite

show abstract

“…Access to transportation is a barrier for people seeking all types of healthcare, in both urban and rural settings [26]. However, delays in care due to distance or transportation can push women seeking abortion to later gestations [8,27,28] and are likely to disproportionately impact low-income women who may struggle to cover the cost of transport and delay care [6,12]. Delays in abortion care may be particularly crucial to women in Wyoming, Alaska, Indiana, South Dakota, and South Carolina, where the abortion facilities had the lowest gestational limits.…”

Section: Abortion Desertsmentioning

confidence: 99%

“…Since we did not conduct mystery shopper calls to all facilities found through our online search (only those that did not advertise their facility gestational limit), we may be missing a level of detail that facilities would provide to potential patients seeking services if they called the facility. In addition, transportation to overcome distance is not the only barrier that people may face in trying to access abortion services -they may also face abortion stigma, waiting periods [10], and state gestational limits [9,28] as a result of state level restrictions. Finally, it is important to acknowledge that the abortion facility that is closest to a where a woman lives may not meet her needs, particularly if it only provides medication abortion, has low limits on the gestations at which it provides abortion care, or cannot serve women with health conditions who may have higher risks.…”

Section: Limitationsmentioning

confidence: 99%

Identifying National Availability of Abortion Care and Distance From Major US Cities: Systematic Online Search (Preprint)

Cartwright¹,

Karunaratne²,

Barr‐Walker³

et al. 2017

Preprint

View full text Add to dashboard Cite

Background: Abortion is a common medical procedure, yet its availability has become more limited across the United States (US) over the past decade. Although women may not always know where to go for abortion care, they often use the internet to find reproductive health information and there appear to be more online searches for abortion in states with more restrictive abortion laws. While previous studies have examined the distances women must travel to reach an abortion provider, to our knowledge no studies have used systematic online searches to document the current geographic locations and services of abortion facilities.Objective: To describe abortion facilities and services available in the United States from the perspective of a potential patient searching online and to identify U.S. cities where people must travel the farthest to obtain abortion care.Methods: In early 2017, we conducted a systematic online search for abortion facilities in every state and the largest cities in each state. We recorded facility locations, types of abortion services available, and facility gestational limits and summarized the frequencies by region and state. If the online information was incomplete or unclear, we called the facility using a mystery shopper methodology, which simulates the perspective of patients calling for services. We also calculated distance to the closest abortion facility from all U.S. cities with populations ≥50,000.Results: 780 facilities were identified through our online search, with the fewest in the Midwest and South. Over 30% of all facilities advertised the provision of medication abortion services only; this proportion was close to 40% in the Northeast and West. The lowest gestational limit at which services were provided was 12 weeks in Wyoming; the highest was 28 weeks in New Mexico. People in 27 U.S. cities must travel over 100 miles to reach an abortion facility; the largest number of such cities is in Texas which has 10.Conclusions: Online searches can provide detailed information about the location of abortion facilities and the types of services they provide. However, these facilities are not evenly distributed geographically and many large U.S. cities do not have an abortion facility. Long distances can push women to seek abortion in later gestations when care is even more limited.

show abstract

Association Between Distance to an Abortion Facility and Abortion or Pregnancy Outcome Among a Prospective Cohort of People Seeking Abortion Online

2022

View full text Add to dashboard Cite

IMPORTANCEMany people face barriers to abortion care, including long distances to an abortion facility. OBJECTIVES To investigate the association of distance to the nearest abortion facility with abortion or pregnancy outcome. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted using data from the Google Ads Abortion Access study, a prospective cohort study of individuals considering abortion recruited between August 2017 and May 2018. Individuals from 50 states and Washington, District of Columbia, who were pregnant and considering abortion based on self-report were recruited online using a stratified sampling technique. Participants completed online baseline and 4-week follow-up surveys. Data were analyzed between May and August 2021. EXPOSURES Driving distance to an abortion facility calculated from participant zip code and grouped into 4 categories (<5 miles, 5-24 miles, 25-49 miles, and Ն50 miles). MAIN OUTCOMES AND MEASURES Abortion or pregnancy outcome reported at 4-week follow-up, categorized as had an abortion, still seeking an abortion, or planning to continue pregnancy. Other measures included reported experience of 8 distance-related barriers to abortion, such as having to gather money for travel expenses and having to keep the abortion a secret. RESULTS Among 1485 pregnant individuals considering abortion who completed the baseline survey and provided contact information, 1005 individuals completed follow-up (follow-up rate, 67.7%) and 856 participants were included in the analytic sample (443 individuals ages 25-34 years [51.8%]; 208 Black individuals [24.3%]; 101 Hispanic or Latinx individuals [11.8%], and 468 White individuals [54.8%]). Most participants had at least some college education (474 individuals [55.5%]). Distance to an abortion facility was less than 5 miles for 233 individuals (27.2%), 5 to 24 miles for 373 individuals (43.6%), 25 to 49 miles for 85 individuals (9.9%), and 50 or more miles for 165 individuals (19.3%) (mean [SD] distance = 28.3 [43.8] miles). Most participants reported at least 1 distance-related barrier (763 individuals [89.1%]), with a mean of 3.3 barriers (95% CI, 3.2-3.5 barriers) reported. For 7 of 8 distance-related barriers, an increased percentage of participants living farther from an abortion facility reported the barrier compared with participants living less than 5 miles from a facility; for example, 61.8% (95% CI, 53.5%-69.4%) of individuals living less than 5 miles reported having to gather money for travel expenses, while 81.2% (95% CI, 70.8%-88.5%; P = .002) of those living 25 to 49 miles and 75.8% (95% CI, 69.9%-81.0%; P = .02) of those living 50 or more miles from a facility reported this barrier. At follow-up, participants living 50 or more miles from a facility had higher odds of still being pregnant and seeking abortion (adjusted odds ratio[aOR] = 2.07; 95% CI, 1.35-3.17; P = .001) or planning to continue pregnancy (aOR = 1.96; 95% CI, 1.06-3.63; P = .03) compared with participants living within 5 miles.

show abstract

Denial of Abortion Because of Provider Gestational Age Limits in the United States

Abstract: Many state laws restrict abortions based on gestational age, and new laws are lowering limits further. The incidence of being denied abortion will likely increase, disproportionately affecting young and poor women.

Cited by 150 publications

References 20 publications

Unintended pregnancy: a framework for prevention and options for midlife women in the US

Unintended pregnancy: a framework for prevention and options for midlife women in the US

Identifying National Availability of Abortion Care and Distance From Major US Cities: Systematic Online Search (Preprint)

Association Between Distance to an Abortion Facility and Abortion or Pregnancy Outcome Among a Prospective Cohort of People Seeking Abortion Online

Contact Info

Product

Resources

About