Differences in abortion service-delivery in clinics by state policy context in 2017

Abstract

Introduction In addition to monitoring the number and location of abortion clinics nationwide, it is important to examine other aspects of service-delivery, such as cost, and number of days abortions are provided, because they influence the accessibility of abortion care. Moreover, state policies can affect the types of care that are provided. This study examines differences in abortion service-delivery in clinics by state policy climate in 2017. Method Data for this study are from the Guttmacher Institute’s 2017 Abortion Provider Census, which collected information from all known abortion-providing facilities in the United States. This analysis focuses on the 808 clinic facilities that provided 95% of abortions that year. Outcomes include the cost of abortion care, maximum gestation at which abortions were offered, number of days clinics provided abortions, and other types of non-abortion services offered. Weights were constructed to account for non-responding facilities. Measures were calculated nationally and according to whether the clinic was in a state with a policy context that we categorized as hostile, middle-ground or supportive of abortion rights. Results In 2017, patients paid an average of $549 for a surgical abortion at 10 weeks gestation; without adjusting for cost-of-living, the amount was highest in middle-ground states ($592) and lowest in hostile states ($534). 64% of clinics offered abortion up to 11 weeks gestation, 22% did so up to 20 weeks, and 13% offered abortion at gestations up to 22 weeks. A slightly higher proportion of clinics in supportive states than hostile offered abortions after 22 weeks. 87% of clinics offered family planning services beyond post-abortion contraception, and the proportion was higher in supportive (93%) than in hostile states (75%). Nationally, clinics provided abortions for a median of 3 days per week. Nearly half of clinics in supportive states provided abortions > =5 days per week (46%), compared to 29% in hostile and middle-ground states. Conclusions Clinics operating in states that are hostile to abortion rights provide abortion services on fewer days and offer fewer non-abortion services. People residing in these states may encounter barriers not just to abortion, but to the wider range of sexual and reproductive health care they need.