Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, United States.
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States.
JMIR Public Health Surveill. 2023 Nov 7;9:e45671. doi: 10.2196/45671.
Even preceding the Supreme Court's 2022 Dobbs v. Jackson Women's Health Organization decision, patients in the United States faced exceptional barriers to reach abortion providers. Abortion restrictions disproportionately limited abortion access among people of color, young people, and those living on low incomes. Presently, clinics in states where abortion remains legal are experiencing an influx of out-of-state patients and wait times for in-person appointments are increasing. Direct-to-patient telehealth for abortion care has expanded since its introduction in the United States in 2020. However, the role of this telehealth model in addressing geographic barriers to and inequities in abortion access remains unclear.
We sought to examine the amount of travel that patients averted by using telehealth for abortion care, and the role of telehealth in mitigating inequities in abortion access by race or ethnicity, age, pregnancy duration, socioeconomic status, rural residence, and distance to a facility.
We used geospatial analyses and data from patients in the California Home Abortion by Telehealth Study, residing in 31 states and Washington DC, who obtained telehealth abortion care at 1 of 3 virtual abortion clinics. We used patients' residential ZIP code data and data from US abortion facility locations to document the round-trip driving distance in miles, driving time, and public transit time to the nearest abortion facility that patients averted by using telehealth abortion services from April 2021 to January 2022, before the Dobbs decision. We used binomial regression to assess whether patients reported that telehealth was more likely to make it possible to access a timely abortion among patients of color, those experiencing food insecurity, younger patients, those with longer pregnancy durations, rural patients, and those residing further from their closest abortion facility.
The 6027 patients averted a median of 10 (IQR 5-26) miles and 25 (IQR 14-46) minutes of round-trip driving, and 1 hour 25 minutes (IQR 46 minutes to 2 hours 30 minutes) of round-trip public transit time. Among a subsample of 1586 patients surveyed, 43% (n=683) reported that telehealth made it possible to obtain timely abortion care. Telehealth was most likely to make it possible to have a timely abortion for younger patients (prevalence ratio [PR] 1.4, 95% CI 1.2-1.6) for patients younger than 25 years of age compared to those 35 years of age or older), rural patients (PR 1.4, 95% CI 1.2-1.6), those experiencing food insecurity (PR 1.3, 95% CI 1.1-1.4), and those who averted over 100 miles of driving to their closest abortion facility (PR 1.6, 95% CI 1.3-1.9).
These findings support the role of telehealth in reducing abortion-related travel barriers in states where abortion remains legal, especially among patient populations who already face structural barriers to abortion care. Restrictions on telehealth abortion threaten health equity.
即使在最高法院 2022 年多布斯诉杰克逊妇女健康组织案之前，美国的患者就已经面临着获得堕胎服务的特殊障碍。堕胎限制不成比例地限制了有色人种、年轻人和低收入人群获得堕胎的机会。目前，在堕胎仍然合法的州，诊所正在接待大量来自其他州的患者，现场预约的等待时间也在增加。自 2020 年在美国引入堕胎护理远程医疗以来，直接面向患者的远程医疗服务有所扩大。然而，这种远程医疗模式在解决堕胎获取方面的地理障碍和不平等问题方面的作用仍不清楚。
我们旨在研究患者通过远程医疗获得堕胎护理而避免的旅行量，以及远程医疗在通过种族或族裔、年龄、妊娠持续时间、社会经济地位、农村居民和到设施的距离来减轻堕胎获取不平等方面的作用。
我们使用地理空间分析和加利福尼亚家庭远程堕胎研究中患者的数据，这些患者居住在 31 个州和华盛顿特区，他们在 2021 年 4 月至 2022 年 1 月多布斯案之前，通过 3 家虚拟堕胎诊所中的 1 家获得远程堕胎护理。我们使用患者的居住邮政编码数据和美国堕胎设施位置数据，记录他们通过远程医疗服务避免的往返驾驶距离（英里）、驾驶时间和往返公共交通时间，这些都是他们在获得最近的堕胎设施时所避免的。我们使用二项式回归来评估远程医疗是否更有可能使有色人种患者、经历粮食不安全的患者、年轻患者、妊娠持续时间较长的患者、农村患者和离他们最近的堕胎设施较远的患者能够及时获得堕胎。
6027 名患者平均避免了 10（IQR 5-26）英里和 25（IQR 14-46）分钟的往返驾驶，以及 1 小时 25 分钟（IQR 46 分钟至 2 小时 30 分钟）的往返公共交通时间。在接受调查的 1586 名患者的一个亚样本中，43%（n=683）报告远程医疗使他们能够及时获得堕胎护理。远程医疗最有可能使年龄在 25 岁以下的年轻患者（PR 1.4，95%CI 1.2-1.6）和 35 岁及以上的患者相比，能够及时获得堕胎护理）、农村患者（PR 1.4，95%CI 1.2-1.6）、经历粮食不安全的患者（PR 1.3，95%CI 1.1-1.4）以及避免前往距离最近的堕胎设施超过 100 英里的患者（PR 1.6，95%CI 1.3-1.9）。
这些发现支持远程医疗在减少堕胎相关旅行障碍方面的作用，特别是在那些已经面临堕胎护理结构性障碍的患者群体中。对远程医疗堕胎的限制威胁到公平的健康权益。
