To examine the association between distance traveled for an abortion and site of postabortion care among low-income women.
We conducted a retrospective cohort study using claims data from 39,747 abortions covered by California's Medicaid program in 2011–2012. Primary outcomes were the odds of abortion-related visits to an emergency department (ED) and the original abortion site, and the secondary outcome was total abortion care costs. We used mixed-effects logistic regression adjusting for patient and abortion characteristics to examine the associations between distance traveled and subsequent abortion-related care at each location.
Among all abortions (N=39,747), 3% (95% CI 2.9–3.3, n=1,232) were followed by an ED visit (3% first-trimester aspirations, 2% second trimester or later, and 4% medication abortions) and 25% (95% CI 24.1–24.9, n=9,745) were followed by a visit to the original abortion site (4% first-trimester aspirations, 3% second-trimester or later, and 77% medication abortions). Women traveling farther for their abortions had higher odds of visiting an ED (100 or more miles compared with less than 25 miles, first-trimester aspirations: adjusted odds ratio [OR] 2.29, 95% CI 1.50–3.49; medication abortions: adjusted OR 2.30, 95% CI 1.34–3.93) and lower odds of returning to their abortion site for follow-up (100 or more miles compared with less than 25 miles, first-trimester aspirations: adjusted OR 0.36, 95% CI 0.18–0.70; second trimester or later: adjusted OR 0.52, 95% CI 0.31–0.88; and medication abortions: adjusted OR 0.33, 95% CI 0.23–0.50). Costs were consistently higher when subsequent care occurred at an ED rather than the abortion site (median cost $941 compared with $536, P<.001).
For most patients, greater distance traveled for abortion was associated with increased likelihood of seeking subsequent care at an ED. Increasing the number of rural Medicaid abortion providers and reimbursing providers for telemedicine and alternatives to routine follow-up would likely improve continuity of care and reduce state costs by shifting the location of follow-up from EDs back to abortion providers.
Traveling greater distances for an abortion is associated with increased likelihood of seeking subsequent care at an emergency department.
Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, and the Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California.
Corresponding author: Ushma D. Upadhyay, PhD, MPH, Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, 1330 Broadway, Suite 1100 Oakland, CA 94612; email: Ushma.Upadhyay@ucsf.edu.
Supported by a research grant from the Society of Family Planning (grant #SFPRF7-12).
Financial Disclosure The authors did not report any potential conflicts of interest.
Presented at the North American Forum on Family Planning, November 5–7, 2016, Denver, Colorado.
The authors thank Angelique Lastinger, MA, Linette Scott, MD, MPH, and John Mikanda, MD, MPH, of the California Department of Health Care Services Information Management Division for access to the Medi-Cal data used for this study; Brian M. Paciotti, PhD, MS, at the California Department of Health Care Services for working with them on our data request; Elise Belusa, MSc, and Roula AbiSamra, MPH, for administration and coordination of the data and research assistance; Alice Cartwright, MPH, for project management; and Tracy Weitz, PhD, MPA, whose work provided early inspiration for the study.
Each author has indicated that she has met the journal's requirements for authorship.