USING THE AMERICAN COMMUNITY SURVEY AND THE MYERS ABORTION DASHBOARD TO DETERMINE THE RELATIONSHIP BETWEEN SPATIAL POLARIZATION AND ACCESS TO IN-PERSON ABORTION CARE

Objectives

We aimed to assess the relationship between spatial polarization and driving times from each US county to the closest abortion clinic before and after Dobbs v Jackson Women’s Health Organization.

Methods

We calculated county-level Index of Concentrations at the Extremes (ICE), which quantifies extremes of disadvantage and privilege and is used as a proxy for structural racism. We calculated the distance from the centroid of each US county to the closest abortion clinic before (March 2022) and after Dobbs (March 2023). We compared travel times before and after Dobbs using a medians test. We used logistic regression to determine ICE quintile predictors of the closest facility being ≥2-hours adjusted for legality of abortion and time period.

Results

We assessed 3,143 US counties. Median travel time increased from 1.6 (range:0.1-6.7) to 2.0 (range:0-11.6) hours post-Dobbs; p<0.001. In logistic regression, those in the most-disadvantaged race and income ICE quintile versus those in the least-disadvantaged quintile had increased odds of living in a county ≥2 hours from an abortion facility of (adjusted OR (aOR) 2.32; 95%CI:1.94–2.79) and the odds of living ≥2 hours from a facility increased by (aOR 2.24; 95%CI:2.01-2.51) post-Dobbs. Similarly, those in the most-disadvantaged ethnicity and income quintiles verses those in the least-disadvantaged quintile had increased odds of living ≥2 hours from an abortion facility of 2.50;95%CI[2.09–3.01]) and the odds of living ≥2 hours from a facility increased by 2.25;95%CI[2.01-2.52] post-Dobbs.

Conclusions

Abortion bans are increasing the travel time to the closest facility which may be increasing barriers to care among communities already facing systemic poverty and structural racism.