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Out-of-state abortion travel and care delays increased in Washington post-Dobbs


Out-of-state abortion travel and care delays increased in Washington post-Dobbs | Image Credit: © Parilov – © Parilov – stock.adobe.com.

Traveling to another state for abortion care and seeking care later in gestation is more common in states with legalized abortion following Dobbs v Jackson Women’s Health Organization (Dobbs), according to a recent study in JAMA Network Open.1

Takeaways

  1. The Dobbs decision led to a rise in the number of patients traveling to states with legalized abortion, such as Washington, for abortion care.
  2. Following Dobbs, there was an increase in the average gestational duration at the time of abortion care, with significant impacts on Hispanic, White, and Black patients.
  3. The impact of state abortion bans disproportionately affected Black, White, and American Indian women, with varying increases in gestational duration and delays in care.
  4. There was a slight decrease in weekly procedural abortions post-Dobbs, while the number of medication abortions remained unchanged.
  5. The study highlights the need to improve access to abortion care for out-of-state patients, who often face longer gestational periods and higher costs.

Following the Supreme Court decision in 2022 to overturn the federal right to abortion, state trigger bans and abortion restrictions were implemented across the United States. This has led to an increase of out of state travel for abortion and increased travel time. However, it is unclear how Dobbs impacted these outcomes in states with legal abortion.

Currently, abortion is legal in Washington state. The state borders Idaho, where abortion is completely banned. State laws in Washington protect clinicians providing abortion care from investigations in other states.

Data has also indicated increased impacts from state abortion bans on Black, White, and American Indian women.2 The prevalence ratios for living in a state with an abortion ban were 1.17, 1.59, and 1.02 for these demographics, respectively.

Investigators conducted a study to evaluate changes and delays in abortion care after Dobbs in Washington state. Abortions between January 1, 2017, and July 31, 2023, at Cedar River Clinics were included in the analysis.1 Care was provided for up to 26 weeks’ gestation.

Electronic medical records were evaluated for data about sociodemographic characteristics, zip code of residence, abortion type, abortion timing, and gestational duration. Administrative records were assessed for appointment scheduling date and call data.

Measures included self-identified race and ethnicity, primary language, and residential zip code. The patient’s primary payment method was also reported.

Type of abortion, gestational duration, time to appointment, and patient state of residence were the primary outcomes of the analysis. Document pregnancies with missing gestational duration or unknown location were excluded from the gestational duration analysis.

There were 18,379 pregnancies included in the analysis, 3378 of which occurred after Dobbs. Patients were aged a mean 28.5 years when receiving abortion care, and 72% of abortions were procedural.

Of patients, 13% were Asian, 23% Black, 14% Hispanic, and 31% White. Public insurance was reported by 61% and English as their primary language by 92%.

An increase in the number of weekly abortions per week of 6.35 was observed following the Dobbs decision. Increases in the average gestational duration and number of patients from out of state were also reported, of 6.9 days and 2 patients, respectively.

A slight decrease of -0.12 was observed for weekly procedural abortions following Dobbs. There was no change in medication abortions. Increases in gestational duration were 8.1 days for Hispanic patients, 7.9 days for White patients, and 4.7 days for Black patients. The increase was not significant among Asian patients.

Time to appointment was not significantly altered following Dobbs in the overall population, but a significant increase of 1.6 days among Black patients and 1.5 among White patients was reported. The proportion of abortions from patients out of state increased from 4% to 6%, with more out of state patients being Indigenous and White.

Out of state patients more often received procedural abortions, self-paid for their abortions, sought care for a fetal indication, and had a higher gestational duration than in-state patients. The proportions of Indigenous out of state patients decreased from 22% to 8% after Dobbs, while proportions of Black and Hispanic patients increased.

These results indicated delays to care and abortion provision in Washington state. Investigators concluded these findings should be used to improve access for patients seeking abortion care.

References

  1. Riley T, Fiastro AE, Benson LS, Khattar A, Prager S, Godfrey EM. Abortion provision and delays to care in a clinic network in Washington state after Dobbs. JAMA Netw Open. 2024;7(5):e2413847. doi:10.1001/jamanetworkopen.2024.13847
  2. Kunzmann K. State abortion bans more frequently affect Black, White, American Indian women. Contemporary OB/GYN. May 3, 2024. Accessed June 3, 2024. https://www.contemporaryobgyn.net/view/state-abortion-bans-affect-black-white-american-indian-women



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