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Abortion-care disruptions exert disproportionate impact

Service disruptions at the start of the COVID-19 pandemic altered and exacerbated geographic disparities in access to abortion care in Louisiana, according to a study published in Contraception.

“These findings reinforce the importance of developing mechanisms to support pregnant people during emergency situations when traveling to a nearby clinic is no longer possible,” authors wrote.1

As Louisiana became an early COVID-19 hotspot, on March 21, 2020, the state’s Department of Health issued a directive limiting medical-care provision to essential services and emergency procedures. This climate created both legal questions over whether abortion was an essential service and logistical hurdles involving clinic capacity, provider and staff availability, and procurement of supplies.

Previous research by the same investigators showed that between March and May 2020, service disruptions at Louisiana facilities contributed to a 31% reduction in the number of abortions, along with significant increases in second-trimester abortions (adjusted odds ratio/AOR: 1.91; 95% confidence interval/CI = 1.10-3.33), and a significant decrease in the number of medication abortions.2

In the new study, investigators assessed how geographic patterns of service disruption impacted all abortions performed for Louisiana residents at the state’s 3 abortion clinics between January 1, 2018, and May 31, 2020. “In this analysis,” authors wrote, “we found that observed changes in the number, timing, and type of abortions were concentrated among residents in particular areas of the state.”

“Mystery client” calls made between April 2 and July 8, 2020, revealed that only one clinic (Clinic A) stayed open and consistently scheduled appointments. A second clinic was open for 2 of the 6 weeks, while a third remained shuttered throughout. Clinic A was the only clinic for which median distance traveled increased between early 2019 and early 2020—57 miles versus 102 miles, respectively, with women in Central Louisiana being hit hardest.

Stratified models showed that for residents whose closest clinic closed, total monthly abortions decreased 46%; the odds of a second-trimester abortion significantly increased (AOR = 2.35; 95% CI: 1.21-4.56); and the likelihood of a medication abortion significantly decreased (AOR = 0.59; 95% CI: 0.39-0.87). “The loss of one’s closest clinic—even if it is not particularly close to home— had a measurable impact on access to abortion care,” authors wrote.

Although unexpected, the decrease in pharmaceutical abortions occurred because such abortions were less common at Clinic A than the other sites. “The statewide change thus reflected specific clinic practices, a further indication of how individual clinic closures, whether temporary or permanent, can affect the ability of pregnant people to realize their abortion preferences,” authors said.

Pandemic aside, they added, people in rural communities, the Midwest, and South have long faced increasing distances to reach abortion providers. The US Supreme Court’s recent Dobbs v. Jackson Women’s Health Organization decision likely will escalate this trend. “As during the pandemic,” authors concluded, “the availability of medication abortion post-Dobbs—at clinics, through telehealth, and self-sourced over the Internet—will be critical to providing safe and effective options for those experiencing service disruptions due to their geographic location.”

REFERENCES:

1. Berglas NF, White K, Schroeder R, Roberts SCM. Geographic disparities in disruptions to abortion care in Louisiana at the onset of the COVID-19 pandemic. Contraception. 2022;115:17-21. doi:10.1016/j.contraception.2022.07.012

2. Roberts SCM, Berglas NF, Schroeder R, Lingwall M, Grossman D, White K. Disruptions to abortion care in Louisiana during early months of the COVID-19 pandemic. Am J Public Health. 2021;111(8):1504-1512. doi:10.2105/AJPH.2021.306284