Joint Medical Program, University of California San Francisco and University of California Berkeley, San Francisco and Berkeley, CA, USA.
Advancing New Standards in Reproductive Health, Department of Obstetrics Gynecology and Reproductive Sciences, University of California San Francisco, Oakland, CA, USA.
Contraception. 2024 Aug;136:110476. doi: 10.1016/j.contraception.2024.110476. Epub 2024 Apr 26.
Identify factors associated with presenting for abortion after 10 weeks' gestation in a large, geographically diverse sample.
From October 2019 to March 2020, we surveyed 1089 patients seeking abortion at seven U.S. facilities. We identified four domains of barriers: geographic, financial, logistical/personal, and legislative. Using multivariable logistic regression, we investigated the relationship between each domain and presenting for abortion after 10 weeks' gestation, overall and stratified by state policy landscape.
One-third of participants reported geographic (33.0%), financial (33.3%), and logistical/personal (31.4%) barriers; fewer (4.8%) reported legislative barriers. One-third (30.8%) traveled over 50 miles to the clinic. One-quarter (25.2%) presented after 10 weeks' gestation. In multivariable analyses, financial barriers (adjusted odds ratio [aOR] = 1.49, 95% confidence interval [CI] = 1.06-2.09), geographic barriers (aOR = 2.05, 95% CI = 1.44-2.90), and difficulty meeting basic expenses (aOR = 1.47, 95% CI = 1.15-1.89) were associated with presenting after 10 weeks' gestation across the seven clinics. Among participants accessing care at clinics in states with supportive abortion policies (n = 178), geographic barriers remained significantly associated with presenting after 10 weeks' gestation.
In a large, geographically diverse sample, financial and geographic barriers were associated with presenting after the threshold for medication abortion. In supportive states, the association with geographic barriers persisted. Cost and geographic barriers are increasing as more states restrict abortion post-Dobbs, highlighting the urgent need to expand financial and travel support.
People seeking abortion faced barriers before the Dobbs decision. Now, post-Dobbs, restrictions to abortion have only increased, making barriers to care even more threatening. Providing access to financial resources and transportation for people seeking abortion and expanding telehealth medication for abortion is now even more important.
在一个大型、地理多样化的样本中，确定与妊娠 10 周后堕胎就诊相关的因素。
2019 年 10 月至 2020 年 3 月，我们对美国 7 家医疗机构的 1089 名寻求堕胎的患者进行了调查。我们确定了四个障碍领域：地理、财务、后勤/个人和立法。使用多变量逻辑回归，我们研究了每个领域与妊娠 10 周后堕胎就诊之间的关系，总体上并按州政策环境进行分层。
三分之一的参与者报告存在地理（33.0%）、财务（33.3%）和后勤/个人（31.4%）障碍；较少（4.8%）报告存在立法障碍。三分之一（30.8%）的人到诊所的路程超过 50 英里。四分之一（25.2%）的人在妊娠 10 周后就诊。在多变量分析中，财务障碍（调整后的优势比[aOR]为 1.49，95%置信区间[CI]为 1.06-2.09）、地理障碍（aOR 为 2.05，95%CI 为 1.44-2.90）和难以满足基本支出（aOR 为 1.47，95%CI 为 1.15-1.89）与 7 家诊所的妊娠 10 周后就诊相关。在接受支持堕胎政策的州的诊所就诊的参与者中（n=178），地理障碍与妊娠 10 周后就诊仍显著相关。
在一个大型、地理多样化的样本中，财务和地理障碍与药物流产门槛后就诊相关。在支持堕胎的州，地理障碍的关联仍然存在。随着更多的州在多布斯案后限制堕胎，堕胎的成本和地理障碍只会增加，这凸显了扩大经济和旅行支持的迫切需要。
在多布斯案之前，寻求堕胎的人就面临着障碍。现在，在多布斯案之后，堕胎限制只增加了，使获得护理的障碍更加严重。为寻求堕胎的人提供经济资源和交通支持，并扩大远程医疗药物流产，现在变得更加重要。
