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Greater travel distance to abortion services associated with lower abortion rates

Many states have implemented policies restricting abortion care clinicians and facilities. Such policies often result in clinic closures and inability to access care, which disproportionately impacts low-income women and non-white women. Clinic closures often result in increased travel to receive care. Increased travel for abortion is associated with delays in care, increased costs and stress. Previous research has shown that people are less likely to obtain abortion care the farther they live from an abortion care facility. New research from Bixby members examined the association between travel distance to the nearest abortion care facility and rates of abortion.

Key Findings

Researchers found that greater travel distances were associated with lower abortion rates.
Statistical modeling showed that if abortion were to be integrated into primary care, over 15,000 additional abortions were estimated.
If telemedicine were widely available, an additional 70,000+ abortions were estimated.

Study Design

This geographic analysis used publicly available data from 27 states, the American Community Survey, and the US Census to calculate county-level abortion rates per 1000 female residents of reproductive age (15-44 years) in 2015, the most recent year of county-level data available when the study began. We compare abortion rates across counties with varying median travel distances to the nearest abortion facility. We estimated the abortion rate for 48 states and estimated the effect of different travel distance scenarios on the abortion rate in a multivariable model. Data were collected from April 2018 to October 2019. 


These results suggest that reducing travel distances to abortion facilities would increase access, even in states without restrictive laws and that integrating abortion into primary care or making medication abortion care available by telemedicine may decrease unmet need. As states continue to enact laws restricting abortion access, it is likely that distance to care will continue to grow. In order to mitigate these impacts, a public health approach to abortion would use strategies such as expanding the types of clinicians who can offer care, mobile clinics, telemedicine, and mail order delivery of medications.

A public health approach to abortion would use strategies that have increased access to other forms of medical care, including expanding the types of clinicians who can offer care, mobile clinics, telemedicine, dispensing via lockboxes, and mail order delivery of medications. Such public health approaches will become even more important if the U.S. Supreme Court gives states more leeway to regulate or ban abortion. 

The article, Association of Travel Distance to Nearest Abortion Facility With Rates of Abortion, is available in JAMA Network Open.