Escaping an Abortion Desert Isn’t as Simple as Crossing State Lines

(Bloomberg) -- As states like Texas and Oklahoma restrict abortion access ahead of a pivotal Supreme Court decision, Americans are being forced to travel farther from home to access care. But leaving town to escape restrictive laws is neither an easy solution nor an equitable one.

Texas is a case in point. Following the signing of a law that bans abortion after about six weeks, an average of 1,400 Texans a month are traveling outside the state for abortions, according to a March study from the University of Texas at Austin’s Texas Policy Evaluation Project. The majority head for New Mexico or Oklahoma — a plan that has now been complicated by the Oklahoma legislature’s April 5th passage of a total abortion ban.

Traveling to access abortions is not new. In 2017, for example, about 12% of pregnant people living in states with restrictive abortion laws sought care elsewhere in the U.S., according to a study in The Lancet. That included over half the patients living in Mississippi, Missouri, South Carolina, and Wyoming. Patients traveling out of state face additional obstacles: clinics can be booked weeks in advance and costs — for childcare, time off work, gas, and travel — can be prohibitive, exacerbating inequality of access.

A 2018 study published in the Journal of Medical Internet Research found that people living in 27 cities with populations above 50,000 would need to travel more than 100 miles to reach the nearest abortion clinic, a distance commonly referred to as an “abortion desert.”  Fifteen of the 27 cities cited are located in Texas. With the U.S. awaiting the Supreme Court decision in Dobbs v. Jackson Women’s Health Organization, such deserts could widen. Ohio residents, for example, would have to travel up to 300 miles to reach the nearest clinic, assuming they could obtain an appointment at all.

Here’s a brief overview on the current state of abortion deserts, and why the concept is far more complex than a simple square-mile radius:

What is an abortion desert?

As the 2018 study illustrated, abortion deserts exist where people have to travel 100 miles or more to reach the nearest clinic.  But other factors, including cost and availability of appointments, are also barriers to access.

“Distance is definitely a crude measure of people’s access that is relatively easy to collect and model,” said Alice Cartwright, one of the study’s authors. “We know that people’s lives are much more complicated.” 

Cities cited in the study tend to be in states that do not cover abortion costs through Medicaid, another reason patients are forced to leave home. 

“Sometimes the closest clinic might be right across the border,” said Mikaela Smith, a research scientist at The Ohio State University. “But sometimes it can mean having to travel really, really far.” 

Of the seven states where Texas residents currently travel to receive an abortion, only New Mexico covers abortion services through Medicaid. In the past five months, people have had to wait as many as 22 days for an appointment at one of the seven clinics available, the University of Texas at Austin study found. Roughly half of women in New Mexico live in counties that don’t have a clinic at all. 

Who can travel to receive an abortion, and who can’t?

According to the Guttmacher Institute, 59% of people seeking abortion care already have at least one child, and three-quarters have incomes that are near or below the federal poverty line. “What those distances mean really depends on the resources of the person who's seeking abortion care,” said Liza Fuentes, a senior research scientist with the group.

Traveling 10 miles may be prohibitive to someone who doesn’t have a driver’s license, or cannot afford child care or time off work, she said. “The impact of any restriction, any ban, any effort to make it more difficult to get an abortion or shame people for having an abortion, will have a disproportionately negative impact on people who have fewer resources to overcome those barriers,” she said. 

Respondents to the University of Texas at Austin study said they fell behind on bills, and could not afford food after paying for abortions. Others said they were fired from their jobs for missing work, or that their performance at school was impacted because of the timing of their care.

“A very large number of Texas residents have been able to get their abortions out of state, but this is coming at a heavy financial, emotional, and sometimes social costs to people, and I don't think that that should be forgotten,” said Kari White, an associate professor at the University of Texas at Austin and the lead investigator with the Texas Policy Evaluation Project, which follows the impact of Texas legislation on women’s reproductive health. 

What does the future of abortion access look like?

Depending on how the Supreme Court rules on Dobbs v. Jackson Women’s Health Organization, the already precarious situation for people in states like Oklahoma and Texas may become even less tenable.

“As we heard from people in our interviews, sometimes Oklahoma was just as far as they could go,” said White. If the state’s new abortion ban takes effect, Oklahomans seeking abortions, as well as the 600 Texans who travel there each month, could be left without care.

Meanwhile, the longer people have to wait to receive an abortion, the more difficult it can become to get one — and the more it impacts other elements of their lives. The University of California, San Francisco’s Turnaway Study found that women who were denied abortions and gave birth experienced an increase in poverty levels that lasted for years. 

For those who do eventually manage to get one, delays may change the type of termination required — to a more invasive procedure, for example — which could become quality-of-care issue.

“There’s a lot more to talk about in terms of the impact of abortion restrictions, besides the distance to the nearest clinic.”

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