Warren Alpert Medical School, Brown University, Providence.
Institute for Research and Education to Advance Community Health, Washington State University, Seattle.
Perspect Sex Reprod Health. 2020 Dec;52(4):227-234. doi: 10.1363/psrh.12164. Epub 2020 Dec 17.
Although one in four U.S. women has an abortion in her lifetime, barriers to abortion persist, including distance to care. This study evaluates the association between distance to care and the abortion rate, adjusting for abortion demand.
Two analyses were conducted using a data set linking provider locations and 2000-2014 county-level abortion data for 18 states; data sources included the Census Bureau, state vital statistics offices and the Guttmacher Institute. First, a series of linear regression models were run, with and without adjustment for demographic covariates, modeling distance as both a continuous and a categorical variable. Then, an instrumental variable analysis was conducted in which being 30 or more miles from a large college-enrolled female population younger than age 25 was used as an instrument for distance to a provider. The outcome variable for all models was abortions per 1,000 women aged 25 or older. All models were adjusted for state, year and state-year interaction fixed effects.
Increased distance to a provider was associated with a decreased abortion rate. Each additional mile to a provider was associated with a decrease of 0.011 in the abortion rate. Compared with being within 30 miles of a provider, being between 30 and 90 miles from a provider was associated with 0.80-1.46 fewer abortions per 1,000 women. In the instrumental variable analysis, being 30 or more miles from a provider was associated with 5.26 fewer abortions per 1,000 women.
Distance to a provider may present a barrier to abortion by preventing access to care. Therefore, policies that increase travel distances have potential for harm.
尽管四分之一的美国女性在其一生中会选择堕胎，但堕胎障碍仍然存在，包括获得护理的距离。本研究评估了与护理距离相关的堕胎率，同时调整了堕胎需求。
本研究使用了一个将提供者位置与 18 个州 2000 年至 2014 年县一级堕胎数据相联系的数据集，包括人口普查局、州立人口统计办公室和盖特马赫研究所，进行了两项分析。首先，进行了一系列线性回归模型分析，包括和不包括人口统计学协变量的调整，以连续和分类变量的形式建模距离。然后，进行了工具变量分析，其中距离 30 英里或以上的大型大学生群体（年龄小于 25 岁）被用作距离提供者的工具变量。所有模型的结果变量均为每 1000 名 25 岁或以上女性的堕胎数。所有模型均调整了州、年份和州-年份交互固定效应。
与提供者的距离增加与堕胎率下降相关。与提供者的距离每增加一英里，堕胎率就会下降 0.011。与距离提供者 30 英里以内相比，距离提供者 30-90 英里与每 1000 名女性减少 0.80-1.46 次堕胎相关。在工具变量分析中，距离提供者 30 英里或以上与每 1000 名女性减少 5.26 次堕胎相关。
与提供者的距离可能通过阻碍获得护理而成为堕胎的障碍。因此，增加旅行距离的政策可能会造成伤害。
