Study: Travel times to get an abortion jump following Dobbs decision

Many women are facing extreme travel times to get an abortion, researchers found in one of the first studies to assess the impact of the Dobbs v. Jackson Women’s Health Organization decision.

Benjamin Rader, MPH, of the computational epidemiology lab at Boston Children’s Hospital, and colleagues sought to understand changes in travel time to the closest facility providing abortions after the Supreme Court overturned Roe v. Wade this summer.

The researchers used the most recent U.S. Census data to assess how many women between the ages of 15 and 44 years lived in each census tract. Once a computer model divided the U.S. into square-kilometer units, Rader and colleagues then evaluated the median travel time through each unit. They compared access during what the researchers called “the pre-Dobbs period” and “the post-Dobbs period.”

“This study ... found significantly longer travel times to abortion facilities post-Dobbs ... compared with pre-Dobbs,” the researchers wrote.

The study revealed that about 33% of “women of reproductive age” are facing excessive travel times when seeking abortions, and twice as many women now have to travel at least 60 minutes — “double the U.S. government benchmark for reasonable access to primary care,” according to a press release related to the study.

Rader and colleagues also found significant disparities based on race, socioeconomic status and geographic area.

Only about 15% of Black women had to drive an hour before the Supreme Court’s decision, compared with 40% now. People with lower mean incomes and rates of health insurance also face hour-long trips disproportionately.

“This has been a real gap in the research,” study coauthor Ushma Upadhyay, PhD, a professor of obstetrics, gynecology and reproductive science at the University of California, San Francisco, said in the release. “We have always more or less known that abortion bans affect Black and other people of color the most, but this research provides direct evidence of how these communities are being disproportionately affected by the Supreme Court’s action.”

Broken down by race, the researchers found:

• a 25.6 (sensitivity interval [SI], 24.2-27) percentage-point increase in Black women living more than 1 hour from an abortion facility, from 10.9% (SI, 9.8-12.4) to 36.4% (SI, 35.9-37.1);
• a 21.7 (SI, 20.5-23) percentage-point increase in Hispanic women living more than 1 hour from an abortion facility, from 8.6% (SI, 7.8-9.9) to 30.3% (SI, 29.9-31.1), vs non-Hispanic women, who experienced an 18 (SI, 15.4-20.6) percentage-point increase, from 16% (SI, 14.3-18.6) to 33.9% (SI, 32.9-35.7);
• a 20.4 (SI, 15.4-25.5) percentage-point increase in American Indian or Alaska Native women living more than 1 hour from an abortion facility, from 33.9% (SI, 30.3-38.9) to 54.4% (SI, 52.3-57.6);
• a 14.1 (SI, 13.8-14.5) percentage-point increase in Asian women living more than 1 hour from an abortion facility, from 3.4% (SI, 3.1-3.7) to 17.5% (SI, 17.3-17.8%);
• an 11.8 (SI, 10.7-12.8) percentage-point increase in Native Hawaiian or Pacific Islander women living more than 1 hour from an abortion facility, from 11.2% (SI, 10.3-12.1) to 23% (SI, 22.5-23.6); and
• an 18 (SI, 15.1-20.8) percentage-point increase in white women living more than 1 hour from an abortion facility, from 17.1% (SI, 15.2-19.9) to 35% (SI, 33.8-36.9).

Geographically, the researchers found that people who lived in the South had the most severe consequences for travel times, “as an entire bloc of states ceased to provide abortion services,” according to the release. In states that have 6-week or complete abortion bans, travel times jumped by an average of 4 hours.

Before the court’s decision, people in Louisiana and Texas had to travel about 15 minutes to get an abortion. Now, the median is more than 6 hours. The average increase in Texas was 8 hours.

“We need to understand the diminished access to this essential health service in order to better understand what resources we need to invest to regain that access. We were startled to see that populations of major metropolitan areas now have to travel several hours for care,” study coauthor Yulin Hswen, ScD, an assistant professor of epidemiology and biostatistics at the University of California, San Francisco, said in the release.

References:

• Model shows where women lost access to abortion after Dobbs. https://www.ucsf.edu/news/2022/10/424121/model-shows-where-women-lost-access-abortion-after-dobbs. Published Nov. 1, 2022. Accessed Nov. 4, 2022.
• Rader B, et al. JAMA. 2022;doi:10.1001/jama.2022.20424.