By: Kalani Phillips, MPH, CPH
States including Oklahoma, Ohio, and Texas have passed bills banning abortion in early pregnancy. These restrictive policies interfere with an individual’s ability to make their own reproductive decisions and increases their risk of experiencing poor health outcomes including poverty, physical health impairments, and intimate partner violence. Research indicates that these policies do not actually reduce the rate of abortions occurring, but only decrease the safety of the procedure. While medication abortion has been proven to be both medically safe and effective, these restrictive policies have been linked to poorer health outcomes regarding racial, socioeconomic, and geographic disparities. As these negative health outcomes stemming from a lack of access mainly affect already vulnerable communities, it is imperative that these disparities be addressed.
Racial & Socioeconomic Disparities
The current disparities in abortion rates parallel other predominating disparities seen in the U.S. For example, research indicates that disparities in health outcomes based on socioeconomic and racial factors continue to persist. People of color and individuals from lower socioeconomic backgrounds tend to have increased rates of abortion; however, this is likely due to higher rates of unintended pregnancy and decreased access to contraceptives. For instance, research found that rates of unintended pregnancy were highest among LatinX, Black, and low-income women. Moreover, a National Survey of Family Growth found that about 70% of all pregnancies among Black women and 57% of all pregnancies among LatinX women were unplanned, as compared to 42% among White women. However, while these individuals are known to have higher abortion rates, they are also less likely to have access to abortion services.
The racial, ethnic, and socioeconomic differences in abortion access are also linked to the fact that most Black and LatinX communities either do not have insurance coverage or use publicly funded insurance, are low-income, and are less likely to be located near an abortion clinic. The impacts of decreased abortion access can be grim, as communities of color and low-income groups have higher rates of poor health outcomes, decreased quality of life, increased financial insecurity, reduced aspirational life plans, increased incidence of serious pregnancy complications, increased risk of intimate partner violence, and poorer physical health post-pregnancy. In addition, Black individuals are disproportionately impacted by limitations in abortion acccess and experience increased rates of maternal and infant mortality as compared with other non-LatinX White individuals. Increasing access to medication abortion is therefore critical to empower these communities to take charge of their life trajectories.
While most abortions are performed through abortion clinics, the number of abortion clinics decreased in nearly 50% of U.S. states in 2011 to 2014, where some areas had over a 20% decrease in clinics. Additionally, 90% of U.S. counties do not have an abortion provider, forcing many women to seek abortions outside of the county they live in or to travel outside of state. Other geographic disparities persist as well. For example, individuals living in rural areas, the Midwest, or the South lack access to abortions. These sharp declines in access underscore the fact that many individuals living in underserved or disadvantaged communities must travel far to even obtain an abortion.
Research has been conducted to see what access to abortion would look like if Roe is overturned. One study assessed how Ohio’s proposed abortion bans would affect travel distance to access care. Using a legal analysis of abortion laws following the overturning of Roe, the researchers calculated distances from each county to the nearest abortion clinic, concluding that overturning Roe could increase the driving distance by up to 269 miles for Ohioians. As abortion care is healthcare, it should not be this difficult to obtain an abortion. An individual should not have to travel over 200 miles for reproductive care, and every person should have the right to decide if and when they have a child.
While restrictive abortion policies have continued to increase, telehealth has proven successful in increasing access to medication abortion throughout the pandemic. In fact, the FDA approved the abortion pill to be mailed during the COVID-19 pandemic. This shift to remote and online options greatly improved access for many, yet in many states, mostly in the Midwest and South, telehealth visits for medication abortion is banned, forcing individuals within that state to travel to states with more access. In situations where an individual does not have a means of transportation, the financial stability to travel, or the time to take off work, this option may not be available. This can be detrimental, as some legal experts state that efforts to increase access through a “black market” may emerge. Considering that more restrictive abortion policies have not resulted in a decrease in abortion rates and can contribute to unregulated access to the medication, a policy needs to be advanced to safely deliver medication abortion to individuals who desire it. Given the recent success of both mailing abortion pills and using telehealth to increase access to medication abortion, policymakers should seek to make these policies permanent even after the COVID-19 pandemic is over.
Abortion access is a critical component of reproductive health care and empowers individuals with the right to make decisions about what happens to their bodies. Research has found that the ability to decide if, when, and how to give birth has been associated with increased economic success, educational attainment, and positive health outcomes. Moreover, limiting abortion access has been shown to affect minority and low socioeconomic groups by decreasing quality of life and increasing the risk of poor health outcomes. A national policy to address these disparities in access is therefore critically needed.
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