Kari White1, Gracia Sierra2, Teairra Evans3, Sarah C M Roberts4. 1. Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, United States; Population Research Center, The University of Texas at Austin, Austin, TX, United States. Electronic address: kariwhite@utexas.edu. 2. Population Research Center, The University of Texas at Austin, Austin, TX, United States. Electronic address: gracia.sierra@utexas.edu. 3. Department of Psychology, University of Alabama, Tuscaloosa, AL, United States. Electronic address: tzevans@crimson.ua.edu. 4. Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, Oakland, CA, United States. Electronic address: sarah.roberts@ucsf.edu.
Abstract
OBJECTIVE: To assess the association between indicators of economic disadvantage and geographic accessibility of reproductive health services and abortions ≥ 12 weeks' gestation in Mississippi. STUDY DESIGN: This cross-sectional study used data on Mississippi residents who obtained abortion care from 12 of 14 facilities in Mississippi, Alabama, Louisiana, and Tennessee in 2018. We estimated logistic regression models to assess the association between levels of county deprivation, the number of obstetrician and/or gynecologists per 10,000 women, and one way distance to the nearest facility with having an abortion ≥ 12 weeks' gestation. We compared the median one-way distance to the facility where patients < 12 weeks', 12-15 weeks', and ≥ 16 weeks' gestation received care, using Kruskal-Wallis tests. RESULTS: Of the 4,455 Mississippi residents who obtained abortions, 73% were Black, 59% lived ≥ 50 miles from a facility, and 60% obtained care in Mississippi. Overall, 764 (17.2%) abortions were performed ≥ 12 weeks' gestation. In adjusted models, those in counties with moderate (OR, 1.47; 95% CI: 1.15-1.90) and high (OR: 1.36, 95% CI: 1.01-1.83) (vs low) levels of economic deprivation and counties with 0.1-1.4 (vs ≥ 2.5) obstetrician/gynecologists per 10,000 women (OR: 1.55; 95% CI: 1.06-2.27) had higher odds of obtaining an abortion ≥12 weeks' gestation. Mississippi residents who obtained abortions ≥ 16 weeks' gestation traveled a median 143 miles one way to the facility where they received care, compared to 69 miles and 60 miles traveled by those < 12 weeks' and 12-15 weeks' gestation, respectively (p < .001). CONCLUSIONS: Many Mississippi residents obtained abortion care ≥ 12 weeks' gestation, which is related to greater economic constraints and limited geographic access to reproductive health services. IMPLICATIONS: People's need for abortions ≥ 12 weeks' gestation may be higher in communities with limited access to reproductive health services and among those living in areas with greater economic disadvantage. State laws that narrow gestational limits would increase long-distance travel for later abortion care, and disproportionately affect those with fewer resources.
OBJECTIVE: To assess the association between indicators of economic disadvantage and geographic accessibility of reproductive health services and abortions ≥ 12 weeks' gestation in Mississippi. STUDY DESIGN: This cross-sectional study used data on Mississippi residents who obtained abortion care from 12 of 14 facilities in Mississippi, Alabama, Louisiana, and Tennessee in 2018. We estimated logistic regression models to assess the association between levels of county deprivation, the number of obstetrician and/or gynecologists per 10,000 women, and one way distance to the nearest facility with having an abortion ≥ 12 weeks' gestation. We compared the median one-way distance to the facility where patients < 12 weeks', 12-15 weeks', and ≥ 16 weeks' gestation received care, using Kruskal-Wallis tests. RESULTS: Of the 4,455 Mississippi residents who obtained abortions, 73% were Black, 59% lived ≥ 50 miles from a facility, and 60% obtained care in Mississippi. Overall, 764 (17.2%) abortions were performed ≥ 12 weeks' gestation. In adjusted models, those in counties with moderate (OR, 1.47; 95% CI: 1.15-1.90) and high (OR: 1.36, 95% CI: 1.01-1.83) (vs low) levels of economic deprivation and counties with 0.1-1.4 (vs ≥ 2.5) obstetrician/gynecologists per 10,000 women (OR: 1.55; 95% CI: 1.06-2.27) had higher odds of obtaining an abortion ≥12 weeks' gestation. Mississippi residents who obtained abortions ≥ 16 weeks' gestation traveled a median 143 miles one way to the facility where they received care, compared to 69 miles and 60 miles traveled by those < 12 weeks' and 12-15 weeks' gestation, respectively (p < .001). CONCLUSIONS: Many Mississippi residents obtained abortion care ≥ 12 weeks' gestation, which is related to greater economic constraints and limited geographic access to reproductive health services. IMPLICATIONS: People's need for abortions ≥ 12 weeks' gestation may be higher in communities with limited access to reproductive health services and among those living in areas with greater economic disadvantage. State laws that narrow gestational limits would increase long-distance travel for later abortion care, and disproportionately affect those with fewer resources.
Authors: Amy J H Kind; Steve Jencks; Jane Brock; Menggang Yu; Christie Bartels; William Ehlenbach; Caprice Greenberg; Maureen Smith Journal: Ann Intern Med Date: 2014-12-02 Impact factor: 25.391