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Title: Factors hindering access to abortion services.
Author: Henshaw SK.
Journal: Fam Plann Perspect; 1995; 27(2):54-9, 87. PubMed ID: 7796896.
Abstract:
Although abortion services are readily available in large urban areas to those able to pay, a 1993 survey of U.S. abortion providers shows that access to service is still problematic for many women because of barriers related to distance, gestation limits, costs and harassment. Among women who have nonhospital abortions, an estimated 24% travel at least 50 miles from their home to the abortion facility. Although 98% of providers will perform abortions at eight weeks after the last menstrual period, only 48% will perform abortions at 13 weeks and 13% at 21 weeks. Half of nonhospital abortion providers estimate that more than four days elapse on average between their patients' first telephone contact and the date of the procedure; one in seven say that more than one week elapses. Most women are able to obtain abortion services in one visit to a clinic. The average woman having a first-trimester nonhospital abortion with local anesthesia paid $296 for the procedure in 1993, up from $251 in 1989. On average, nonhospital facilities charged $604 at 16 weeks of gestation and $1,067 at 20 weeks. Eighty-six percent of nonhospital facilities providing 400 or more abortions in 1992 were the targets of antiabortion harassment. Picketing at facilities and the homes of staff members, vandalism and chemical attacks increased significantly between 1988 and 1992, but the incidence of bomb threats decreased. 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.

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