Factors hindering access to abortion services.

ABSTRACT

PIP: In 1988, 1.6 million US women had abortions, and 1.7 carried unintended pregnancies to term. Little is known about why unintended pregnancies are carried to term, but financial, physical, psychological, social, or other obstacles to abortion are undoubtedly important as well as lack of knowledge about the availability of services. This fact is borne out by the wide discrepancy in the abortion rates in various states (ranging from 9/1000 women aged 15-44 years in South Dakota to 45.8 in California in 1988). Data from the Alan Guttmacher Institute's 1993 Abortion Provider Survey reveal that 24% of women travel at least 50 miles to obtain abortion services; that 98% of providers will perform abortions at 8 weeks since last menstrual period, 48% at 13 weeks, and 13% at 21 weeks; that most women receive an abortion 4-7 days from their initial inquiry in a single visit to a clinic (this time reflects an increase in recent years and may grow worse due to the provider shortage); and that providers charge $296 for an average first-trimester nonhospital abortion with local anesthesia, $604 at 16 weeks gestation, and $1067 at 20 weeks. The exclusion of abortion from Medicaid coverage in most states results in a severe legislative restriction for poor women. In addition, the data show that 86% of the clinics which provided 400 or more abortions in 1992 were the targets of anti-abortion harassment. Between 1988 and 1992, the picketing of abortion facilities and the homes of staff members increased, as did attacks with butyric acid. Although the incidence of bomb threats decreased, the recent murders of providers, escorts, and staff indicate gradually increasing violence. If abortions were integrated with other health care services for women, most of the difficulties in obtaining and providing access would disappear. This change is unlikely, however, as long as vocal opposition to abortion remains. An alternative is the use of RU-486, which has the potential to change the types of abortion providers and to reduce some of the barriers in some cases. Medical abortion, however, can be used only in early pregnancy and requires 2 visits to a clinic as well as surgical backup.