Women who travel long distances for abortions are more likely to go to an emergency room for any follow-up care even when they’re not necessarily experiencing an emergency, according to new research out Tuesday.
The study is the first to examine the connection between the distance traveled for abortion and where women subsequently seek follow-up care. And though the research, published in the journal Obstetrics and Gynecology, was conducted in California—a state with no major abortion restrictions and more than 500 abortion-providing facilities—its lead author said the findings have implications in the large swaths of the country with severe abortion restrictions or few clinics.
“Increasing the number of abortion providers in rural areas, including in states where there is only one abortion provider, could help reduce the number of [emergency department] visits, thereby reducing state costs, and increase continuity of care,” said Ushma Upadhyay, associate professor at the University of California, San Francisco (UCSF), in an email to Rewire.
Nationally in 2008, women traveled an average of 30 miles one-way for an abortion. In restrictive states, which often require more than one visit and are home to few clinics, those distances can rise to hundreds of miles.
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The research team from Advancing New Standards in Reproductive Health (ANSIRH), a reproductive health research group based at UCSF, examined data from 2011 and 2012 from nearly 40,000 abortions covered by Medi-Cal, California’s Medicaid program. They found women who traveled 100 miles or more to end their pregnancies were more than two times as likely to go to the emergency department for follow-up care than women who traveled fewer than 25 miles one-way. This difference pushed Medicaid costs higher, because visiting the emergency room costs the state more. A median emergency room visit for follow-up abortion care ran about $961, while an abortion provider visit was $536.
Visiting the emergency department didn’t necessarily mean patients experienced a medical emergency, the authors noted. Patients sought follow-up care for myriad reasons, including to confirm the abortion was complete and to ask questions about symptoms.
And visits to the emergency department were rare, occurring in only 3 percent of cases studied. By contrast, a quarter of patients studied returned to the original abortion provider for follow-up care. But longer distances made this less likely.
“Ideally, patients would return to their original abortion provider because they are ones most familiar with the side effects she should expect and are best equipped to treat any adverse events such as an incomplete abortion,” Upadhyay told Rewire. “But for some women, particularly low-income women, it’s just too burdensome because it means taking time off from work, arranging for childcare, and planning for transportation for another 100+ mile trip.”
The authors found California’s massive geography posed a challenge to certain groups of pregnant people, particularly those in underserved rural areas, who are more likely to travel 50 miles one way or more for abortion services.
“It’s just intuitive that the longer a woman travels for care, the less likely she is going to travel all the way back if she has concerns or questions about the symptoms she is experiencing,” Upadhyay said.
The authors make policy recommendations to reduce the number of emergency room visits, such as reimbursing providers that offer medication abortion via telemedicine and providing more terminations in primary care settings, like a doctor’s office.
The research builds on the the team’s prior work. A study published earlier this year showed that half of Medi-Cal patients in rural areas traveled 50 miles or more for abortion services.