Abortion-related catastrophic health expenditures tied to adverse mental health symptoms

Key takeaways:

• A study conducted pre-Dobbs found 42% of patients seeking abortion care incurred catastrophic health expenditures.
• Catastrophic health care expenditures were tied to increased anxiety and depressive symptoms.

Women who traveled out of state for abortion care were more likely to incur catastrophic health expenditures, which were associated with increased symptoms of anxiety and depression, survey data show.

In a cross-sectional study conducted before the Dobbs v. Jackson Women’s Health Organization decision, researchers found that 42% of women who sought abortion care incurred such catastrophic expenditures, suggesting a need for expanded insurance coverage for abortion care.

“Many individuals seeking abortion care face catastrophic health expenditures, associated with adverse mental health symptoms,” Ortal Wasser, MSW, a doctoral student and adjunct faculty member at New York University Silver School of Social Work, told Healio. “Compounded by higher direct and indirect costs, individuals who needed to travel from out of state to reach care were significantly more likely to incur catastrophic health expenditures. These high rates of abortion-related catastrophic health expenditures suggest a need for expanded insurance coverage for abortion care, regardless of the state of residence.”

Assessing abortion-related costs, mental health

Researchers administered surveys between January and June 2019 to 675 people aged 15 to 45 years seeking abortion in four clinics located in three abortion-supportive states (California, Illinois and New Mexico). The mean age of participants was 27 years, with 55% aged 20 to 29 years. Most (71%) sought abortion before 12 weeks’ gestation. Participants completed self-administered questionnaires while awaiting their abortion appointment. Researchers assessed patients’ travel for abortion care, categorized as out-of-state or in-state based on the participants’ state of residence and the clinic location. Main outcomes were self-reported abortion care costs and additional non-health care costs, including transportation, accommodation and missed work. Such costs were considered catastrophic if they were 40% or greater of a person’s ability to pay, defined as the monthly income remaining after meeting subsistence needs. Researchers examined the associations between catastrophic health expenditures, out-of-state travel for abortion care and mental health symptoms including stress, anxiety and depression.

The findings were published in JAMA Network Open.

About half of participants (49%) lived more than 25 miles from the abortion clinic where they sought care and 31% traveled out of state for care, according to researchers. Those who traveled out of state were more likely to seek abortion after 20 weeks’ gestation, planned to pay out of pocket for the abortion and lived more than 100 miles away from the clinic vs. those who sought in-state care.

Compared with people who sought in-state care, those who traveled out of state for abortion care also incurred higher total mean out-of-pocket costs ($1,367 vs. $411), including for the abortion ($838 vs. $153) and for other additional non-health care costs ($569 vs. $268).

Within the cohort, researchers estimated that 42% of patients incurred abortion-related catastrophic health expenditures. Such costs were associated with anxiety (adjusted prevalence ratio [APR] = 1.13; 95% CI, 1.07-1.19) and depression (APR = 1.25; 95% CI, 1.12-1.39).

Researchers found those who traveled out of state for care were more likely to incur catastrophic health expenditures compared with patients who sought in-state care (65% vs. 32%; APR = 2.24; 95% CI, 1.67-3).

“Alongside promoting and expanding insurance coverage, policy efforts should prioritize ensuring accessible and timely abortion care to alleviate the financial burden faced by individuals and their households, regardless of their state of residence,” the researchers wrote.

Expenditures changing post-Dobbs

The researchers noted that abortion care has changed substantially post-Dobbs, with the proliferation of telehealth access to medication abortion, which for some lowered overall costs and reduced or even eliminated travel-related costs. However, increased abortion restrictions in some states are also driving more people to seek out-of-state care.

“The financial and psychological burdens of abortion seeking have likely worsened after the Dobbs decision, as more people need to cross state lines to reach a clinic,” Wasser told Healio. “Future research should explore the role of telehealth and abortion funds in mitigating these burdens.”

For more information:

Ortal Wasser, MSW, can be reached at ow345@nyu.edu.