Abstract
BackgroundAccess to abortion care in the United States is limited by the availability of abortion providers and their geographic distribution. We aimed to assess how far women travel for Medicaid-funded abortion in California and identify disparities in access to abortion care.MethodsWe obtained data on all abortions reimbursed by the fee-for-service California state Medicaid program (Medi-Cal) in 2011 and 2012 and examined distance traveled to obtain abortion care by several demographic and abortion-related factors. Mixed-effects multivariable logistic regression models were constructed to examine factors associated with traveling 50 miles or more. County-level t-tests and linear regressions were conducted to examine the effects of a Medi-Cal abortion provider in a county on overall and urban/rural differences in utilization.Results11.9% (95% CI: 11.5–12.2%) of women traveled 50 miles or more. Women obtaining second trimester or later abortions (21.7%), women obtaining abortions at hospitals (19.9%), and rural women (51.0%) were most likely to travel 50 miles or more. Across the state, 28 counties, home to 10% of eligible women, did not have a facility routinely providing Medi-Cal-covered abortions.ConclusionsEfforts are needed to expand the number of abortion providers that accept Medi-Cal. This could be accomplished by increasing Medi-Cal reimbursement rates, increasing the types of providers who can provide abortions, and expanding the use of telemedicine. If national trends in declining unintended pregnancy and abortion rates continue, careful attention should be paid to ensure that reduced demand does not lead to greater disparities in geographic and financial access to abortion care by ensuring that providers accepting Medicaid payment are available and widely distributed.
Highlights
Access to abortion care in the United States is limited by the availability of abortion providers and their geographic distribution
In this study we examine the distances women travel for Medi-Cal-covered abortion care in California, the factors associated with traveling longer distances, and the facilities offering abortion care to Medi-Cal beneficiaries using a unique dataset on abortions covered by California’s state Medicaid program in 2011 and 2012
Statistical analysis First we present the characteristics of the sample and estimated median distance traveled by age, race, urban/ rural residence, procedure type, and source of care
Summary
Access to abortion care in the United States is limited by the availability of abortion providers and their geographic distribution. We aimed to assess how far women travel for Medicaid-funded abortion in California and identify disparities in access to abortion care. Access to abortion care in the United States (US) is limited by the availability of abortion providers—the number of providers, their geographic distribution, and their willingness to accept insurance. In California, 45% of counties (home to 5% of CA women 15–44) had no abortion provider [1]. Existing studies have examined geographic accessibility to abortion, though to our knowledge no study has examined distances traveled by those using Medicaid funds, or more broadly, by low-income women who may be most burdened by additional travel costs and time. Average distance traveled for abortion has been estimated at the national and regional levels for the general population of abortion patients in the United States [3], and distance estimates exist at the state level
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